Intravenous phenytoin has been associated with cutaneous necrosis with major scarring and the need for plastic surgery as a consequence of the extravasation of phenytoin. We report the use of hyaluronidase, a subcutaneous treatment for extravasation of intravenous fluids in newborns, to treat extravasation in a 14-month-old boy.

Hyaluronidase is the enzyme that breaks down hyaluronic acid, the ground substance in the body's connective tissue. In the context of extravasation of intravenous fluids, subcutaneous administration of hyaluronidase breaks down hyaluronic acid, which allows for enhanced distribution and absorption of the extravasated fluids. Hyaluronidase, therefore, reduces tissue damage by decreasing the localized concentration of irritating infiltrated intravenous solutions. It has been useful in extravasation of intravenous aminophylline, calcium, dextrose, nafcillin, parenteral nutrition, and potassium. We are the first to report the use of hyaluronidase with phenytoin extravasation.