Acute hand ischemia after inadvertent intra-arterial injection of crushed zolpidem tablets. A case report and literature review

We report the case of a 26-year-old man with a history of drug addiction who presented to our emergency department with forearm pain and signs of acute ischemia following an inadvertent intra-arterial injection of zolpidem tablets dissolved in tap water. Although relatively rare, this occurrence carries a high risk of inducing acute limb ischemia, which can lead to severe complications such as amputation or even death. The pathophysiology of limb ischemia is multifactorial, influenced by factors including the site of injection, the physicochemical properties of the drug, and the volume injected. Symptoms can range from severe pain without visible lesions to acral ischemia. In all suspected cases of intra-arterial injection, it is crucial to gather information regarding the time of injection, the type of drug used, and whether microcrystalline cellulose is present in the formulation. Current literature underscores the importance of timely diagnosis and a multidisciplinary approach in reducing the risk of amputation. In this case, the immediate combination therapy, including ketamine, iloprost, anticoagulation, and antibiotics was effective in treating the patient.