TY - CHAP M1 - Book, Section TI - Extravasation of Xenobiotics A1 - Wang, Richard Y. A2 - Nelson, Lewis S. A2 - Howland, Mary Ann A2 - Lewin, Neal A. A2 - Smith, Silas W. A2 - Goldfrank, Lewis R. A2 - Hoffman, Robert S. Y1 - 2019 N1 - T2 - Goldfrank's Toxicologic Emergencies, 11e AB - Extravasation injuries are among the most consequential local toxic events. When the vesicant chemotherapeutics leak into the perivascular space, significant necrosis of skin, muscles, and tendons occurs, with resultant loss of function, infection, and deformity. Typical initial manifestations include swelling, pain, and a burning sensation that can last for hours. Days later, the area becomes erythematous and indurated, followed by resolution or progression to ulceration and necrosis. These early findings are often 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) and do not progress to ulceration and necrosis. For example, fluorouracil, carmustine, cisplatin, and dacarbazine are 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 receiving the infused. The extravasation of monoclonal antibodies causes minimal discomfort and inflammation.15,37,49 When a hypersensitivity reaction or an irritation to the vessel cannot be differentiated from extravasation, it is prudent to presume extravasation and manage the situation accordingly. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessemergencymedicine.mhmedical.com/content.aspx?aid=1163022502 ER -