Publication: Conservative management of a severe extravasation injury: A therapeutic nightmare
Date
2025
Journal Title
Journal ISSN
Volume Title
Publisher
Madhesh Institute of Health Sciences (MIHS)
Abstract
ABSTRACT:
Intravenous calcium gluconate is commonly used in neonatal intensive care units (NICU) to treat hypocalcemia in preterm infants, who are especially prone to metabolic disturbances. Although effective, it carries the risk of extravasation injury, which can lead to local tissue necrosis and, rarely, systemic complications such as septic shock. We report a male preterm neonate (gestational age 31+4 weeks; birth weight 1750 g) who developed a significant extravasation injury following intravenous infusion of 10% calcium gluconate on day 1 of life for symptomatic hypocalcemia. Within 24 hours, progressive swelling and superficial skin and subcutaneous tissue necrosis extended from the dorsum of the right ankle to the knee. At presentation to our center on day 16 of life, the neonate was in septic shock, necessitating fluid resuscitation, inotropic support, and mechanical ventilation for 72 hours. Conservative wound management with daily dressing using normal saline and Vaseline gauze was undertaken. The patient’s sepsis resolved with antibiotics, and gradual wound healing occurred without the need for surgical intervention. Extravasation injuries from calcium gluconate are uncommon but can be severe, especially in preterm neonates with fragile skin and immature vasculature. Septic shock as a complication is rarely reported but highlights the critical need for vigilant monitoring. Management typically varies; however, this case demonstrates that timely conservative wound care, combined with supportive therapy, may result in favorable outcomes. This report underscores the importance of prevention, early recognition, and multidisciplinary management to reduce morbidity in this vulnerable population.
Description
Love Kumar Sah1,*, Ashish Jha2, Jitendra Prasad Jayswal2, Shiv Kumar Sah3, Rakesh Yadav4, Sweta Jha5
¹Associate Professor, Department of Pediatrics, Madhesh Institute of health Sciences, Janakpur, Nepal
2Pediatrician, Madhesh Institute of health Sciences, Janakpur, Nepal
3Consultant Pediatrician, Madhesh Institute of health Sciences, Janakpur, Nepal
4Resident, Department of Pediatrics, Madhesh Institute of health Sciences, Janakpur, Nepal
5Hope International College, Lalitpur, Nepal