Hyaluronidase for the management of dextrose extravasation

Intravenous catheter malfunction causing extravasation is a common occurrence in the emergency department (ED). A 17-year-old girl who had a syncopal episode was given an ampule of dextrose 50% water into her antecubital region by emergency medical services. During her evaluation at the ED, she developed erythema and swelling in the antecubital region where the dextrose was given and extravasation was suspected. Most extravasations have relatively minor sequelae, but once an extravasation has occurred, damage can continue for months and involve nerves, tendons, and joints. If treatment is delayed, surgical debridement, skin grafting, and even amputation have been reported in literature. Hyaluronidase is a parenteral protein enzyme traditionally derived from bovine testicular tissue. Hyaluronidase is used as adjunct therapy to increase the absorption and dispersion of other injected drugs. The drug has also been used as an adjunct to nonpharmacologic management of extravasation of selected antineoplastic agents and other irritants. Although hyaluronidase does not have a Food and Drug Administration indication for dextrose extravasation, literature has shown improved outcomes for other hyperosmolar substances. Hyaluronidase was used by injecting 0.2 mL (150 U/1 mL) with a 25-gauge needle at 5 different sites along the leading edge of erythema. The patient's symptoms improved, and there were no complications noted at follow-up at 48 hours and at 6 months. The use of hyaluronidase should be considered for the management of dextrose extravasations and other extravasations.