Patients at risk:
(1) infusion of cytotoxic drug, vasoactive drug or hyperosmolal solution
(2) infusion into dorsum of hand or antecubital fossa
(3) person with fragile blood vessels, especially the elderly
(4) pressurized fluid administration
(5) unable to report symptoms due to age, sedation, coma, or general anesthesia
Clinical features:
(1) tense edema, with or without bullae
(2) pain on passive muscle stretching
(3) excessive pain, out of proportion for clinical findings
(4) paresthesias, with loss of 2-point discrimination
(5) paresis of regional muscles
Diagnostic studies:
(1 high serum CK, reflecting rhabdomyolysis
(2) elevated compartment pressures (normal <= 8 mm Hg)
Treatment:
(1) Discontinue infusion.
(2) Fasciotomy is recommended for compartment pressures >= 30 mm Hg.
