RT Book, Section
A1 Wang, Richard Y.
A2 Hoffman, Robert S.
A2 Howland, Mary Ann
A2 Lewin, Neal A.
A2 Nelson, Lewis S.
A2 Goldfrank, Lewis R.
SR Print(0)
ID 1108438781
T1 Special Considerations
T2 Goldfrank's Toxicologic Emergencies, 10e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071801843
LK accesspharmacy.mhmedical.com/content.aspx?aid=1108438781
RD 2024/04/19
AB Extravasation  injuries  are  among  the  most  consequential  local  toxic  events.  When  certain  chemotherapeutics  leak  into  the  perivascular  space,  significant  necrosis  of  skin,  muscles,  and  tendons  can  occur  with  resultant  loss  of  limb  or  function.  The  initial  manifestations  may  include  swelling,  pain,  and  a  burning  sensation  that  can  last  for  hours.  Days  later,  the  area  can  become  erythematous  and  indurated,  followed  by  resolution  or  progression  to  ulceration  and  necrosis.35  These  early  findings  can  be  difficult  to  distinguish  from  other  forms  of  local  drug  toxicity,  such  as  irritation  and  hypersensitivity,  which  can  result  from  the  chemotherapeutic  or  its  vehicle  (ethanol,  propylene  glycol).  For  example,  fluorouracil,  carmustine,  cisplatin,  and  dacarbazine  are  considered  as  local  irritants.  The  local  irritation  and  hypersensitivity  manifestations  are  self-limiting  and  typified  by  an  immediate  onset  of  a  burning  sensation,  pruritus,  erythema,  and  a  flare  reaction  of  the  vein  being  infused.  Hypersensitivity  reactions  are  reported  with  daunorubicin,  doxorubicin,  idarubicin,  and  mitoxantrone.  Pretreatment  with  an  antihistamine  can  prevent  some  of  the  hypersensitivity  manifestations.43  When  a  local  reaction  cannot  be  differentiated  from  an  extravasation,  it  is  prudent  to  presume  extravasation  has  occurred  and  manage  the  situation  accordingly.