Intramuscular hemorrhage

Complications associated with i.m. administration include nerve injury, muscle contracture, and abscess formation. Less common problems include intramuscular hemorrhage, cellulitis, skin pigmentation, tissue necrosis, muscle atrophy, gangrene, and cyst or scar formation. In addition, injury may occur from broken needles and inadvertent injection into a joint or vein. ... 

Spontaneous fracture(s), often observed as hind-leg paralysis, are frequently observed in rodents young rats are more susceptible to fractures than are mature rats. When treatment is stopped, the fractures heal and do not recur. Extensive subcutaneous and/or intramuscular hemorrhages commonly occur and are often manifestations of hypothrombinemia. Internal hemorrhage is frequently observed. Inflammation of nasal passages, gut, and conjunctivae are sometimes noted. 

Hematologic effects Bivalirudin is not intended for intramuscular administration. Although most bleeding associated with the use of bivalirudin in PCI occurs at the site of arterial puncture, hemorrhage can occur at any site. 

Carboprost has been used successfully to control postpartum bleeding that was secondary to loss of uterine tone and where the myometrium was unresponsive to oxytocin, ergonovine, or methylergonovine. Given intramuscularly, carboprost causes an almost immediate and sustained uterine contraction. Clinical experience has shown that the use of this agent has saved many women from operative interventions (including hysterectomy) to control postpartum hemorrhage. 

At the sites of Injection of oxime in the rabbits, various extents of hemorrhage and of purulent, indurative myositis and muscle necrosis were seen. The rabbits that received physiologic saline and five that received intramuscular injections of 2.15 M sodium chloride on 8 d in a satellite experiment had waxy degeneration of muscle at the site of injection. Five rabbits that received intramuscular injections of 2.15 M I on 8 d also had waxy degeneration of muscle at the site of injection. This was stated to be more extensive than that seen in the rabbits given equimolar sodium chloride. No other lesions in the rabbits that seem to be attributable to the oximes were described. 

Deficiency of vitamin K in the newborn Newborns have sterile intestines and cannot initially synthesize vitamin K. Because human milk provides only about one fifth of the daily requirement for vitamin K, it is recommended that all newborns receive a single intramuscular dose of vitamin K as prophylaxis against hemorrhagic disease. 

Over the first 6 weeks of postnatal life, the plasma concentrations of clotting factors gradually rise to the adult level in the meantime, they are at risk of potentially fatal hemorrhage that was formerly called hemorrhagic disease of the newborn and is now known as vitamin K deficiency bleeding in infancy. It is usual to give all newborn infants prophylactic vitamin K, either orally or by intramuscular injection (Sutor et al., 1999). At one time, menadione was used, but, because of the association between menadione and childhood leukemia (Section 5.6.1), phylloquinone is preferred. 

SAFETY PROFILE Poison via ingestion, intramuscular, parenteral, intraperitoneal, and intravenous routes. Experimental teratogenic effects. Human systemic effects by intramuscular route hemorrhage and... 

Vitamin B12 deficiency can also cause megaloblastic anemia. White-centered hemorrhages can occur in the posterior pole, and disc pallor also may be seen. If the anemia is severe, cotton-wool spots may appear. A complete blood count can confirm that megaloblastic anemia exists. Serum folate and vitamin B12 levels should be determined and appropriate therapy (intramuscular injections of hydroxocobalamin) should be instituted at the earliest sign of megaloblastic anemia. 

Nicolau syndrome (embolia cutis medicamentosa) is a very rare complication of intramuscular injections, in which there is extensive necrosis of the injected skin area, perhaps due to accidental intra-arterial and/or para-arterial injection (233). It usually occurs in children in a review of 102 patients, 80 were under 12 years of age (234). Complications can include everything from an ischemic syndrome with local necrosis of the skin, subcutaneous tissue, and muscle, often combined with vascular and nervous system involvement, intestinal and renal hemorrhage, necrosis of the entire leg, and even paraplegia from spinal cord damage (235-241). Necrosis of the forearm has been described in two patients after inadvertent intra-arterial administration of dicloxacillin (242). 

Vitamin K is routinely administered in many countries to newborn babies in varying doses and by various routes, most commonly either orally or by intramuscular injection, to prevent hemorrhagic disease of the newborn (see Table 1). 

Hemorrhagic disease of the newborn can develop readily because of (1) poor placental transfer of vitamin K, (2) hepatic immaturity leading to inadequate synthesis of coagulation proteins, and (3) the low vitamin K content of early breast milk. Prothrombin levels during this period are only about 25% of the adult levels. Severe diarrhea and antibiotics used to suppress diarrhea readily exacerbate the situation, so prothrombin levels can drop below 5% of the adult level and bleeding can occur. This condition is routinely prevented by the prophylactic administration of 0.5 to 1.0 mg of phylloquinone intramuscularly, or 2.0 mg given orally immediately after birth. 

When an initially painful intravenous or intramuscular injection must be administered repetitively, patient reluctance develops. Injection pains are usually accompanied by hemorrhage, edema, inflammation, and tissue necrosis." Among the factors responsible for painful injections, the most important are the drug solubility in aqueous medium, the viscosity, the pH and the hypo- or hyperosmotic character of the injected drug solution, the amount of the injected volume, the site of injection, the pain tolerance of the patient, and the technique of administration. Other factors include precipitation of the drug at the injection site, and localized cell lysis. ... 

Intramuscular Toxicity. On a molar basis, HCN and NaCN are both equitoxic, and more toxic than KCN. Signs appear within minutes, and include rapid breathing weak and uncoordinated movements, ataxia, tremors, convulsions, and respiratory arrest. Postmortem features are few, and include alveolar and subpleural hemorrhages, and congestion of tracheal mucosa (Ballantyne et ah, 1972). 

A number of clinical trials have demonstrated the benefit of administering antenatal corticosteroids for the prevention of respiratory distress syndrome, intraventricular hemorrhage, and death in infants delivered prematurely. The current chnical recommendation is to administer betamethasone 12 mg intramuscularly every 24 hours for two doses or dexamethasone 6 mg intramuscularly every 12 hours for four doses to pregnant women between 24 and 34 weeks gestation who are at risk for preterm delivery within the next 7 days. Benefits from antenatal corticosteroids are believed to begin within 24 hours. It has been found that repeat corticosteroid administration does not produce any improvement in outcomes for infants and may trend toward harm. ... 

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