Clinical response to unintentionally rapid infusion of drotrecogin alfa (activated)

The case of a patient with severe sepsis who received a bolus dose of 184 microg/kg of drotrecogin alfa (activated) over one hour is reported. An 84-year-old woman who had undergone right total knee replacement was admitted to the hospital from a rehabilitation facility with an initial diagnosis of mental status changes and a suspected urinary tract infection. Examination of the patient's incision from her recent knee surgery revealed a discharge, and a culture was obtained. The patient was diagnosed with sepsis, intubated, and transferred to the intensive care unit. Multiple antibiotics were administered, but the patient's condition continued to deteriorate. In addition, the patient developed acute renal failure, required a ventilator, had cyanotic limbs, and had partially compensated metabolic acidosis. On hospital day 7, drotrecogin alfa (activated) was initiated. She inadvertently received an infusion of 184 microg/kg of drotrecogin alfa over 1 hour. Nine hours later, she received drotrecogin alfa 24 microg/kg/hr for 95 hours. The patient's clinical status was improved after the initial infusion. Peripheral limb cyanosis was markedly decreased, with pink, warm extremities. In addition, the patient's clinical laboratory test values improved after administration of drotrecogin alfa. However, the patient was unable to recover fully from the acute kidney failure and was discharged to hospice care. A drotrecogin alfa dose of 184 microg/kg i.v. was erroneously administered over 1 hour to a patient with sepsis. Nine hours later, a drotrecogin alfa infusion of 24 microg/kg/hr was started and continued for 95 hours. The patient improved clinically and had no apparent adverse events.