Abstract:Calcium gluconate extravasation is a process, which, although infrequent, is associated with serious skin and soft-tissue lesions, mainly affecting infants. Further studies are needed to determine possible specific procedures to be carried out in these cases.
“…The use of calcium in cases of hyperkalemia associated with digoxin toxicity was not associated with life-threatening dysrhythmias or mortality in human studies [36–38]. Finally, calcium may cause tissue injury (i.e., skin necrosis) in case of extravasation [39]. The recommended dose is 10–20 mL of a 10% calcium salt (e.g., 1–2 g of gluconate or chloride).Fig.…”
Purpose
To review the mechanisms of action, expected efficacy and side effects of strategies to control hyperkalemia in acutely ill patients.
Methods
We searched MEDLINE and EMBASE for relevant papers published in English between Jan 1, 1938, and July 1, 2018, in accordance with the PRISMA Statement using the following terms: “hyperkalemia,” “intensive care,” “acute kidney injury,” “acute kidney failure,” “hyperkalemia treatment,” “renal replacement therapy,” “dialysis,” “sodium bicarbonate,” “emergency,” “acute.” Reports from within the past 10 years were selected preferentially, together with highly relevant older publications.
Results
Hyperkalemia is a potentially life-threatening electrolyte abnormality and may cause cardiac electrophysiological disturbances in the acutely ill patient. Frequently used therapies for hyperkalemia may, however, also be associated with morbidity. Therapeutics may include the simultaneous administration of insulin and glucose (associated with frequent dysglycemic complications), β-2 agonists (associated with potential cardiac ischemia and arrhythmias), hypertonic sodium bicarbonate infusion in the acidotic patient (representing a large hypertonic sodium load) and renal replacement therapy (effective but invasive). Potassium-lowering drugs can cause rapid decrease in serum potassium level leading to cardiac hyperexcitability and rhythm disorders.
Conclusions
Treatment of hyperkalemia should not only focus on the ability of specific therapies to lower serum potassium level but also on their potential side effects. Tailoring treatment to the patient condition and situation may limit the risks.
Electronic supplementary material
The online version of this article (10.1186/s13613-019-0509-8) contains supplementary material, which is available to authorized users.
“…The use of calcium in cases of hyperkalemia associated with digoxin toxicity was not associated with life-threatening dysrhythmias or mortality in human studies [36–38]. Finally, calcium may cause tissue injury (i.e., skin necrosis) in case of extravasation [39]. The recommended dose is 10–20 mL of a 10% calcium salt (e.g., 1–2 g of gluconate or chloride).Fig.…”
Purpose
To review the mechanisms of action, expected efficacy and side effects of strategies to control hyperkalemia in acutely ill patients.
Methods
We searched MEDLINE and EMBASE for relevant papers published in English between Jan 1, 1938, and July 1, 2018, in accordance with the PRISMA Statement using the following terms: “hyperkalemia,” “intensive care,” “acute kidney injury,” “acute kidney failure,” “hyperkalemia treatment,” “renal replacement therapy,” “dialysis,” “sodium bicarbonate,” “emergency,” “acute.” Reports from within the past 10 years were selected preferentially, together with highly relevant older publications.
Results
Hyperkalemia is a potentially life-threatening electrolyte abnormality and may cause cardiac electrophysiological disturbances in the acutely ill patient. Frequently used therapies for hyperkalemia may, however, also be associated with morbidity. Therapeutics may include the simultaneous administration of insulin and glucose (associated with frequent dysglycemic complications), β-2 agonists (associated with potential cardiac ischemia and arrhythmias), hypertonic sodium bicarbonate infusion in the acidotic patient (representing a large hypertonic sodium load) and renal replacement therapy (effective but invasive). Potassium-lowering drugs can cause rapid decrease in serum potassium level leading to cardiac hyperexcitability and rhythm disorders.
Conclusions
Treatment of hyperkalemia should not only focus on the ability of specific therapies to lower serum potassium level but also on their potential side effects. Tailoring treatment to the patient condition and situation may limit the risks.
Electronic supplementary material
The online version of this article (10.1186/s13613-019-0509-8) contains supplementary material, which is available to authorized users.
“…All four of the studies rated as ‘poor’ lacked a clearly defined study population. Compaña, Míguez & de Toro Santos 23 , Harris, Bradley & Moss 24 , and von Heimburg & Pallua 29 did not clearly state their objective whilst Cochran, Bomyea & Kahn 12 , Harris, Bradley & Moss and von Heimburg & Pallua lacked clearly-defined, valid and reliable outcome measures.Compaña, Míguez & de Toro Santos did not clearly describe the study’s intervention and von Heimburg & Pallua’s subject were not comparable. In combination, these factors led to the overall ‘poor’ rating of these four studies, meaning that their results were at high risk of methodological bias.…”
Section: Resultsmentioning
confidence: 98%
“…Nine studies (98 children) used management plans comprising debridement and further surgery in combination with conservative measures, details of which are shown in Table 4. 10,13–15,21,23,25,30,32 Of those 98 children, 34 (35%) had established full thickness skin injury / skin necrosis at presentation and 28 (29%) developed necrosis after conservative measures. 84 children (86%) underwent mechanical debridement as part of their treatment.…”
Section: Resultsmentioning
confidence: 99%
“…Thirty-five papers were deemed eligible for inclusion after studies in which conservative management or no intervention were excluded. The requisite data were immediately available in 26 study reports 4,10,[19][20][21][22][23][24][25][26][27][28]11,[29][30][31][32][33][34][12][13][14][15][16][17][18] and the authors of the remaining nine studies 5,[35][36][37][38][39][40][41][42] were contacted twice with additional requests, mainly for exclusively paediatric extravasation data, and given at least two months to reply. Unfortunately, none of the authors were able to provide these data and those studies were excluded.…”
Objectives
This systematic review aims to assess the quality of literature supporting surgical interventions for paediatric extravasation injury and to determine and summarize their outcomes.
Methods
We performed a systematic review by searching Ovid MEDLINE and EMBASE as well as AMED, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews and clinicaltrials.gov from inception to February 2019. All studies other than case reports were eligible for inclusion if the population was younger than 18 years old, there was a surgical intervention aimed at treating extravasation injury and they reported on outcomes. Risk of bias was graded according to the National Institutes of Health (NIH) study quality assessment tools.
Results
26 studies involving 728 children were included. One before and after study and 25 case series. Extravasation injuries were mainly confined to skin and subcutaneous tissues but severe complications were also encountered, including amputation (one toe and one below elbow). Of the surgical treatments described, the technique of multiple puncture wounds and instillation of saline and/or hyaluronidase was the most commonly used. However, there were no studies in which its effectiveness was tested against another treatment or a control and details of functional and aesthetic outcomes were generally lacking.
Conclusion
There is a lack of high quality evidence to support treatment of extravasation injury in children. A definitive trial of extravasation injuries, or a centralized extravasation register using a universal grading scheme and core outcome set with adequate follow up, are required to provide evidence to guide clinician decision-making.
“…El tiempo para curación tuvo una variación de tres a seis meses. Por último, recomendaron que los procedimientos quirúrgicos se llevaran a cabo cuando la evolución no fuera satisfactoria 7. En los tres pacientes que presentamos, inicialmente se utilizó un parche hidrocoloide, a fin de promover la delimitación del área necrótica.…”
RESUMENIntroducción: las quemaduras por extravasación de gluconato de calcio pueden producir complicaciones graves. El objetivo de este artículo es describir la experiencia del manejo de recién nacidos (RN) con este tipo de quemaduras. Presentación de los casos: se trata de tres RN que presentaron quemaduras graves por extravasación de gluconato de calcio. En los tres pacientes el manejo consistió en la utilización de parche hidrocoloide, desbridamiento quirúrgico y colocación de apósito de hidrofibra con plata, hasta completar la cicatrización por segunda intención. Con este tratamiento, los pacientes lograron su recuperación en aproximadamente un mes. Conclusiones: los pacientes con quemaduras por extravasación de gluconato de calcio requieren tratamiento oportuno; las etapas del manejo que hemos descrito parecen ser efectivas.
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