Gangrenous ergotism

Peripheral vasoconstriction, particularly of the hind limbs and forelimbs, can produce hemorrhagic vesiculations that may progress to gangrene. Ergot induced embryotoxicity has been reported with associated fetal malformations and growth retardation. Ergotism may also result in miscarriages. 

Gangrenous ergotism resulted from the vasoconstrictive properties of ergot alkaloids, which reduced flow of blood to the hands and feet. Affected people experienced a burning sensation as tissues of the hands and feet died and rotted due to insufficient blood flow. In addition, hallucinations and dementia were part of the symptoms of ergotism. 

There were two types of ergotism epidemics, convulsive and gangrenous. The epidemics of gangrenous ergotism occurred from the Middle Ages to the nineteenth century. Epidemics of convulsive ergotism arose between 1581 and the last large outbreak in Russia in 1928. Many deaths occurred in these epidemics for example, 8000 people died in one district in France in the epidemic of 1770-1771. 

In gangrenous ergotism the affected part (more often a foot than a hand) became swollen and inflamed. The patient experienced violent, burning pains (hence the Fire of St. Anthony). The affected part gradually became numb, turned black, shrank, and finally became mummified and dry. The gangrenous part often separated spontaneously at a joint. 

Early epidemics of gangrenous ergotism ( holy fire ) were thought to be a sign of divine wrath. The later incidences of convulsive ergotism occurred... 

Ergot alkaloids Ischemia and gangrene fibroplasia of connective tissue uterine contractions, and hallucinations... 

Uses Postpartum bleeding (uterine subinvolution) Action Ergotamine derivative Dose 0.2 mg IM after placental deliv y, may repeat 2-4-h intervals or 0.2-0.4 mg PO q6-12h for 2-7 d Caution [C, ] Contra HTN, PRO Disp Inj, tabs SE HTN, N/V Interactions t Vasoconstriction W/ ergot alkaloids, sympathomimetics, tobacco EMS Tobacco use can t vasoconstriction and lead to a hypertensive crisis OD May cause N/V/D, chest/abd pain, limb numbness, and possibly distal gangrene d/t vasoconstriction activated charcoal may be effective for PO form... 

---