Which agent is effective in treating extravasations involving parenteral alimentation fluids including calcium?

• A. Hyaluronidase
• B. Phentolamine
• C. Topical nitroglycerin
• D. Sodium bicarbonate

Answer: (A)

When a parenteral nutrition solution leaks into tissue, especially one containing calcium, the injury comes from the fluid sitting in the tissue and the calcium causing local irritation and potential necrosis. The goal is to spread and absorb the leaked solution so it doesn’t pool and cause damage.

Hyaluronidase does exactly that. It breaks down hyaluronic acid in the extracellular matrix, increasing tissue permeability. By injecting around the infiltrated area, it helps the calcium-containing fluid diffuse away from the injection site, promoting dispersion and absorption. This reduces local concentration and pressure, lowering the risk of tissue necrosis and helps healing proceed.

The other options work in different extravasation scenarios. Phentolamine is used to reverse vasoconstriction from vasopressors, thereby improving perfusion in vasopressor extravasations. Topical nitroglycerin also helps by vasodilating to restore blood flow in vasopressor-related injuries. Sodium bicarbonate isn’t the standard antidote for TPN calcium extravasation and doesn’t address the diffusion problem in the same way hyaluronidase does.