Extravasation of Parenteral Nutrition in the Neck: A Case Report

Davidoss, Nishant Hemanth; Ha, Jennifer F.

doi:10.15761/gimci.1000145

Cited by 1 publication

(2 citation statements)

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“…Several case reports demonstrated skin lesions attributable to the extravasation of hyperosmotic solutions such as arginine monohydrochloride and parenteral fluid containing amino acids [4][5][6][7][8][9]. In severe cases, patients experienced skin necrosis and required surgical treatment [4][5][6]8].…”

Section: Discussionmentioning

confidence: 99%

“…Cutaneous complications caused by extravasation of arginine and parenteral fluid containing amino acids have been described [4][5][6][7][8][9], but the use of high-concentrated amino acid solutions in patients undergoing PRRT is less known. We report two patients who developed cutaneous lesions during the infusion of a lysine and arginine amino acid solution.…”

Section: Introductionmentioning

confidence: 99%

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Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT

2022

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High-concentrated amino acid solution is used to protect the kidneys during peptide receptor radionuclide therapy (PPRT) in patients with neuroendocrine tumors (NETs). Extravasation of the solution can cause cutaneous complications. In this study, we described a 66-year-old man with metastatic medullary thyroid cancer and a 32-year-old woman with metastatic pancreatic NET who developed cutaneous lesions caused by the extravasation of an amino acid solution (25 g of lysine and 25 g of arginine in 1 L of normal saline) during PRRT with [177Lu]Lu-DOTA-TATE. Both were treated conservatively, and these cutaneous lesions gradually improved. The patient with metastatic pancreatic NET rejected the amino acid infusion in subsequent cycles of PRRT and therefore received [177Lu]Lu-DOTA-TATE alone, and her serum creatinine level and estimated glomerular filtration rate (eGFR) remained normal for 2 months after the last treatment. These two cases revealed cutaneous complications resulting from high-concentrated amino acid solution during PRRT because of hyperosmolarity. Health care providers should be aware of this complication to ensure its prevention and appropriate management. Preserved renal function was demonstrated after [177Lu]Lu-DOTA-TATE treatment in the absence of the infusion of a high-concentrated amino acid solution. However, long-term follow-up of renal function is suggested.

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