Table 1

Pharmacological and physicochemical properties of drugs and solvents that can be used for the interpretation of extravasations

Physicochemical propertyCrash card definitionTherapyCommentsFor example
OsmolarityHigh ≥500 mOsm/L
Low ≤200 mOsm/L
200–500 mOsm/L physiological (290 mOsm/L)2
Warm compresses;
possibly
hyaluronidase
Physiological: cold compresses when dispersion/dilution is not indicated
High osmolarity is defined in the crash card as ≥500 mOsm/L which is rather low when reviewing the literature. However, as there is no formal evidence this boundary is used in the crash card2
Higher osmolarity increases the risk of damage
  • Total parenteral nutrition (TPN)

  • Infusion fluids such as glucose 5%, 10%, mannitol 10%, and dextrose 50%, etc

  • Contrast fluids

  • Electrolyte solutions

Cationic solutionsN/AWarm compresses;
possibly hyaluronidase
Be aware of delayed reactions
  • Calcium solutions

  • Potassium solutions

  • TPN

pHPhysiological (7.4)
Low ≤5.0
High ≥9.0
Range considered ‘physiological’: 5.0–9.01 2
Warm compresses;
possibly
hyaluronidase
Physiological: cold compresses when dispersion/dilution is not indicated
Extreme pH <2 and >11 are thought to cause most damage
Closer to 7.4 means lesser damage
Alkaline solutions are more likely to cause damage than acidic solutions
Alkaline
  • Phenytoin

  • Co-trimoxazole

  • Dantrolene

  • Thiopental

  • Trometamol

  • Aciclovir

  • Phenobarbital

  • Epoprostenol


Acidic
  • Vancomycin

  • Amiodarone

  • Doxycycline

  • Esmolol

  • Promethazine

VasopressorsN/AWarm compresses;
phentolamine
Do not use cold compresses because of additional vasoconstriction
  • Terlipressin

  • Desmopressin

  • Dobutamine

  • Dopamine

  • Phenylephrine

    Norepinephrine