Identification of highly concentrated dextrose solution (50% dextrose) extravasation and treatment—a clinical report

Lawson, Sarah; Brady, William; Mahmoud, Ahmed

doi:10.1016/j.ajem.2012.12.010

Cited by 22 publications

(16 citation statements)

References 8 publications

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“…Hyaluronidase, an enzyme that facilitates the degradation of the extracellular matrix, should be Total parenteral nutrition 42,48,53,54 Calcium chloride 10% (2040 mOsm/L) 48,55,56,59 Calcium gluconate (669 mOsm/L) 48,55,56,59 All agents: Direct cellular damage due to osmotic shifts from cellular membrane, cell volume dysregulation, DNA damage, apoptosis, and inflammation. Other agents: Aminophylline (10 mOsm/L) 48 Dextrose 10-50% (504-2520 mOsm/L) 49 Mannitol 20% (1369 mOsm/L) 43 Hypertonic saline (concentration dependent) Dry heat and elevation remain treatment of choice for pH-related extravasations…”

Section: Vasopressorsmentioning

confidence: 99%

“…Hyaluronidase has been successfully used in the treatment of extravasated substances such as 10-50% dextrose, TPN, calcium, radiographic contrast media, potassium, mannitol, aminophylline, and nafcillin (Table 4). 42,[48][49][50] Animal data have also found tissue-sparing effects during hypertonic saline infiltrations. 51 Swelling may resolve as quickly as 15-30 minutes after administration of hyaluronidase.…”

Section: Osmotically Active Agentsmentioning

confidence: 99%

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Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

et al. 2014

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Extravasations are common manifestations of iatrogenic injury that occur in patients requiring intravenous delivery of known vesicants. These injuries can contribute substantially to patient morbidity, cost of therapy, and length of stay. Many different mechanisms are behind the tissue damage during extravasation injuries. In general, extravasations consist of four different subtypes of tissue injury: vasoconstriction, osmotic, pH related, and cytotoxic. Recognition of high-risk patients, appropriate cannulation technique, and monitoring of higher risk materials remain the standard of care for the prevention of extravasation injury. Prompt interdisciplinary action is often necessary for the treatment of extravasation injuries. Knowledge of the mechanism of extravasation-induced tissue injury, agents for reversal, and appropriate nonpharmacologic treatment methods is essential. The best therapeutic agent for treatment of vasopressor extravasation is intradermal phentolamine. Topical vasodilators and intradermal terbutaline may provide relief. Intradermal hyaluronidase has been effective for hyperosmotic extravasations, although its use largely depends on the risk of tissue injury and the severity of extravasation. Among the hyperosmotic agents, calcium extravasation is distinctive because it may present as an acute tissue injury or may possess delayed clinical manifestations. Extravasation of acidic or basic materials can produce significant tissue damage. Phenytoin is the prototypical basic drug that causes a clinical manifestation known as purple glove syndrome (PGS). This syndrome is largely managed through preventive and conservative treatment measures. Promethazine is acidic and can cause a devastating extravasation, particularly if administered inadvertently through the arteriolar route. Systemic heparin therapy remains the accepted treatment option for intraarteriolar administration of promethazine. Overall, the evidence for managing extravasations due to noncytotoxic medications is nonexistent or limited to case reports. More research is needed to improve knowledge of patient risk, prompt recognition of the extravasation, and time course for tissue injury, and to develop prevention and treatment strategies for extravasation injuries.

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Section: Vasopressorsmentioning

confidence: 99%

Section: Osmotically Active Agentsmentioning

confidence: 99%

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

et al. 2014

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“…We believe that in addition to the trauma caused by the intravenous cannula, extravasation of the infusion fluids (normal saline and dextrose) may have occurred, precipitating bullous eruptions and ulceration in our patient. Intravenous dextrose solutions, especially concentrations above 10%, may cause tissue necrosis [10,11]. Tissue damage with bullous eruptions following extravasation of normal saline has also been reported, and clinicians need to be aware of this potential complication [12].…”

Section: Discussionmentioning

confidence: 99%

Recalcitrant Foot Ulceration in a Patient With Type 1 Diabetes Mellitus

Vazeille

Hawker

Chandrasekar

et al. 2020

Cureus

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We describe the case of a middle-aged woman with type 1 diabetes mellitus who presented to the emergency department with diabetic ketoacidosis. An intravenous cannula was inserted into the veins of the dorsum of the right foot due to difficulty in obtaining intravenous access in the upper limb for managing diabetic ketoacidosis. Our patient developed edema and bullae on the dorsum of the right foot and received intravenous antibiotics for bullous cellulitis. Our patient developed ulceration on the dorsum of the right foot and over the next few months was admitted to hospital on several occasions with infected foot ulceration, which required several courses of intravenous antibiotics, larval therapy and surgical debridement of the necrotic eschar and slough. With regular review in the multidisciplinary diabetic foot clinic, the foot ulceration finally healed in eight months. This case highlights the importance of avoiding trauma in any form to the feet of people with diabetes even if aseptic techniques are taken.

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“…Over the years, discussions regarding the choice of IVF selection [5][6][7][8] procedures of IVF that were accepted as standard for patient treatment have shifted to personalized fluid treatment depending on patients' conditions 9,10 . Several types of IVF including normal saline (NS), dextrose and ringer have been commonly used 11,12 . In order to investigate IVF therapy, mostly to test diluents, which are optimal for drug compatibility and stability, experiments have been presented 13 .…”

mentioning

confidence: 99%

Quantitative Investigation into the influence of intravenous fluids on human immune and cancer cell lines

Altay

Vural

Elitaş

2020

Sci Rep

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The effect of intravenous fluids (IVF) has been investigated clinically through the assessment of posttreatment reactions. However, the responses to IVF vary from patient-to-patient. It is important to understand the response of IVF treatment to be able to provide optimal IVF care. Herein, we investigated the impact of commonly used IVFs, Dextrose, NaCl and Ringer on different human cancer (HepG2 (liver hepatocellular carcinoma) and MCF7 (breast adenocarcinoma)) and immune cell lines (U937 (lymphoma) monocyte and macrophages). The effect of IVF exposure on single cells was characterized using hemocytometer, fluorescence microscopy and flow cytometry. Quantitative data on the viability and morphology of the cells were obtained. Our results emphasize that different IVFs demonstrate important differences in how they influence distinct cell lines. Particularly, we observed that the lactated ringer and dextrose solutions altered the viability and nuclear size of cancer and immune cells differently. Our findings present valuable information to the knowledge of cellular-level IVF effects for further investigations in IVF usage on diverse patient populations and support the importance and necessity of developing optimal diluents not only for drug stability but also for patient benefits.

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Identification of highly concentrated dextrose solution (50% dextrose) extravasation and treatment—a clinical report

Cited by 22 publications

References 8 publications

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications

Recalcitrant Foot Ulceration in a Patient With Type 1 Diabetes Mellitus

Quantitative Investigation into the influence of intravenous fluids on human immune and cancer cell lines

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