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Day 44 : All about Inj Alprostadil

November 14, 2022 Monday  Adarsha Hospital, Kundapura

During the rounds of Dr. Adarsha Hebbar in the morning, we saw Pt. Manjunath Naik, who was admitted on 12/11/22 for gangrenous 4th right toe (ring toe). He is k/c/o T2DM,HTN.PVD and his 5th toe (little toe ) was amputated in our hospital few days back.

We had done arterial and venous doppler of right lower limb which showed decreased blood supply to lower part of the lower limb. The 4th toe had turned black and looked very bad. The patient and his attenders were not reluctant for the amputation of the 4th toe. They requested the doctor to save his 4th toe by any means.

At that time Dr. Adarsha Hebbar suggested inj.Prostal ( Alprostadil) 500mcg. He said we will try inj Prostal for 5 days. Even after this injection if there is no improvement,then we have to amputate the 4th toe to save others nearby toes in the future.

Gangrenous toe 

Some details about Inj Prostal (Alprostadil 500mcg)

Prostal Injection is used to treat patent ductus arteriosus (PDA), a heart defect that occurs in newborns. It improves blood circulation in such babies and helps treat this defect.

BENEFITS OF PROSTAL INJECTION

In Treatment of Patent ductus arteriosus (PDA)

Patent ductus arteriosus (PDA) is a persistent opening between the two major blood vessels leading from the heart. Usually this opening closes shortly after birth, but it can remain open and lead to this heart defect in babies. Prostal Injection improves blood flow in such babies who have PDA


Common side effects of Prostal

  • Apnea (absence of breathing)
  • Fever

  • HOW PROSTAL INJECTION WORKS

    Prostal Injection is similar to a natural substance in the body called prostaglandin E1. It works by improving blood flow in newborn babies born with heart defects.
HOW IT WAS ADMINISTERED IN OUR HOSPITAL

We did not get inj Prostal instead we recieved Inj Alpostin ( Alprostadil 500mcg/1ml) which is the same medicine of a different brand which is available in ampule while the former was available in vial.

We needed to give 50mcg BD dose i.e, 100mcg/day.

0.1ml which contains 50mcg was taken in a 1ml syringe and diluted in 100ml NS given over 3hours two times a day. 

The dose mentioned in the label was 0.05- 0.1mcg/kg/min.

Have to wait for 5 days to see the effect.  


15/11/22 ,Tuesday, Adarsha Hospital, Kundapura

Update on Mr.Manjunath Naik

Dressing done today, 4th toe looks same. Wound looks healthy.No improvement on the blackish colour. I took a photo of the 4th toe.

16/11/2022 Wednesday Adarsha Hospital, Kundapura 

Update on Mr.Manjunath Naik

Dressing done today, 4th toe looks better.
 Wound looks healthy and healing. Blackish colour still looks same. 
P.S. - Dr. Adarsh asked why am I taking pics everyday😂
I said to track the improvement.


17/11/2022 Thursday Adarsha Hospital, Kundapura 

Update on Mr Manjunath Naik.

Dressing done today. There is good improvement and the blackish discoloration is getting reduced. Wound is healthy and healing.
There is still hope to save his 4th toe.

18/11/2022 Friday Adarsha Hospital, Kundapura

Update on Mr Manjunath Naik

I didn't attend Dr.Adarsh sir rounds during his visit to Mr. Manjunath because I had a patient waiting in the casuality which needed my presence. But I took his wound pic when his dressing was removed. The 4th digit looks good and healthy. Discoloration has reduced.
19/11/2022 Saturday Adarsha Hospital, Kundapura

Update on Mr Manjunath Naik

Dresses done today. Wound healthy and healing. Blackish discoloration still present but looks like the toe will get amputated in the future. Already damaged part of the 4th toe cannot be corrected . But we need to save other three toes. So till now the treatment is working and blood flow looks good to the toes. 

20/11/2022 Sunday Adarsha Hospital,Kundapura

Update on Mr Manjunath Naik

Missed rounds today. But I visited him before rounds when his dressing was removed. The 4th toe looked healthy but the tip of the toe still looks the same.No improvement seen and looks like that won't be healed. But the lower end of the toe looks good and healthy. He is still hoping that his toe might get saved from amputation.
I have conveyed him that don't keep big hopes on the 4th toe and pray that rest of the toes might get saved. Whatever the damage has been done cannot be corrected but whatever is left needs to be saved.

24/11/2022 Sunday Adarsha Hospital,Kundapura

Update on Mr Manjunath Naik

Missed rounds on 21,22,23 due to various reason. But I finally attended rounds today. The wound looked good and healing. The blackish discoloration on the top is same but the below part looks good. Dr.Adarsh has advised him to amputate the 4th toe to save the remaining toes after the course of Inj Alpostin. 


30/11/2022 Wednesday Adarsha Hospital,Kundapura

Update on Mr Manjunath Naik

Visited him today. Inj Alpostin 15 day dose finished yesterday. The lower part of the toe looked good. But finally Dr.Adarsh decided to amputate his 4th toe today. Because it was already damaged and the blackish part would not recover in the future. So to save the other three toes it was mandatory to amputate the  4th toe. This is the last picture of his 4th toe.


Update on Mr.Manjunath 
He came today for dressing after so many days. It's been 25 days since his amputation of the 4th toe. I took a photo during his dressing.

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