Burn-Like Skin Necrosis in a Patient following Infusion of Sodium Bicarbonate

This is a report of skin necrosis following a leakage of intravenous infusion of 5% sodium bicarbonate injection during the treatment of continuous veno-venous hemodialysis (CVVHD) in a female patient. The patient sequentially suffered from systemic capillary leak syndrome (SCLS), severe sepsis, and multiple organ dysfunction syndromes (MODS). She died due to refractory septic shock and MODS. Burn-like skin necrosis, although rare, is a recognized complication in infusing hyperosmotic solutions through phleboclysis. It is important to discriminate the solution infused via phleboclysis, or to infuse a hyperosmolar solution through a central vein.