Subject extravasation

The clinical scenario and the severity of the volume abnormality dictate monitoring parameters during fluid replacement therapy. These may include a subjective sense of thirst, mental status, skin turgor, orthostatic vital signs, pulse rate, weight changes, blood chemistries, fluid input and output, central venous pressure, pulmonary capillary wedge pressure, and cardiac output. Fluid replacement requires particular caution in patient populations at risk of fluid overload, such as those with renal failure, cardiac failure, hepatic failure, or the elderly. Other complications of IV fluid therapy include infiltration, infection, phlebitis, thrombophlebitis, and extravasation. 

Epileptiform EEG activity has been described in epileptic subjects. Tissue damage after perivenous extravasation is uncommon. Intra-arterial injection of 1% methohexitone may cause gangrene but the risk is much less than that with 2.5% thiopentone. Allergic reactions occur but are uncommon. Indications... 

Hematopoietic suppression with pancytopenia may occur in the first week after completion of therapy. Proctitis, diarrhea, glossitis, cheilitis, and ulcerations of the oral mucosa are common dermatological manifestations include alopecia, as well as erythema, desquamation, and increased inflammation and pigmentation in areas previously or concomitantly subjected to x-ray radiation. Severe injury may occur as a result of local toxic extravasation. 

More research has been devoted to the study of increased vascular permeability than to any other aspect of inflammation, and several excellent reviews on the subject have recently appeared . Increased vascular permeability here refers to the increased tendency for fluid and plasma proteins to pass through the vessel wall into the extravascular space. Various methods of studying the process have been described, usually involving either the assay of extravasated protein or protein-bound dyes such as trypan blue, or the measurement of the degree of swelling produced in a rat s paw after the subcutaneous injection of an irritant (see page 67). 

Sokrab TE, Johansson BB, KaUmo H et al (1988) A transient hypertensive opening of the blood-brain barrier can lead to brain damage. Extravasation of serum proteins and cellular changes in rats subjected to aortic compression. Acta Neuropathol 75 557-565... 

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