Purple Glove Syndrome: A Complication of Intravenous Phenytoin

Hanna, Debra R.

doi:10.1097/01376517-199212000-00011

Cited by 45 publications

(54 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This suggests that female gender is a risk factor, though we cannot comment on whether this is independent of other potentially coincident factors. The median infusion rate was 32.1 mg/min similar to that from Spengler et al of 38 mg/min, though 13 patients had phenytoin administered at a rate of 50 mg/min, the maximum recommended by the manufacturer of IV phenytoin [1,5,42,46,49,53]. We found a majority of IV catheters were 19 gauge or smaller or placed in the hand, consistent with the hypothesis that PGS is associated with infusion into smaller, more fragile veins that are more prone to trauma and possibly microscopic or visible extravasation.…”

Section: Risk Factorsmentioning

confidence: 85%

“…Three cases reported catheter placement and subsequent symptoms in the foot or distal lower extremity, two involving an asphyxiated term baby girl and a 6-month-old male and the third a 16-year-old male. Extravasation around the catheter site was described in 22/58 (37.9 %) cases, though the details of how this was classified were generally not reported [5,16,21,29,32,33,[46][47][48][49]54].…”

Section: Review Of Reported Casesmentioning

confidence: 99%

“…In most cases, signs or symptoms occurred within 12 h of drug administration, including 16 (22.5 %) within 15 min, of which 15 reportedly occurred immediately after drug infusion [4,5,16,21,22,33,46,47]. About one fifth (12/71, 17 %) described development of PGS within 15 min to 2 h and one half (37/71, 52.1 %) within 2 to 12 h after IVadministration of phenytoin.…”

Section: Review Of Reported Casesmentioning

confidence: 99%

“…In 1984, Comer et al first described the association between IV phenytoin administration and rapid onset of discoloration, pain, and tissue necrosis affecting the distal limb through which the drug was intravenously administered. In her 1992 publication, Hanna named a delayed, soft tissue injury of the hand and forearm following IV administration of phenytoin Bpurple glove syndrome^(PGS) [4,5]. Increasing reports of this condition have recently emerged, some involving permanent tissue damage or loss, leading to questions regarding the safety and risk-benefit profile of IV phenytoin [6].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Purple Glove Syndrome after Phenytoin or Fosphenytoin Administration: Review of Reported Cases and Recommendations for Prevention

2015

View full text Add to dashboard Cite

The aim of our study was to identify all previously reported cases of phenytoin-or fosphenytoin-associated purple glove syndrome (PGS) and summarize the most current understanding of the pathophysiology, clinical presentation, diagnosis, and treatment of the disease. We searched the English language references from MEDLINE, EMBASE, CINA HL, TOXNET, and gray literature that featured one or more case descriptions of phenytoin-or fosphenytoin-associated PGS after administration and provided information on the clinical setting of the event and associated outcome(s). Descriptive statistics were employed to summarize relevant facts about the cases. We identified 82 unique cases of parenteral phenytoin-associated PGS and 5 cases of fosphenytoinassociated PGS that were published from 1984 to 2015. Additionally, we found two cases of PGS associated with oral formulation of phenytoin published from 1999 to 2015. The spectrum of tissue injury ranged from mild local cutaneous reactions around the infusion site to frank limb ischemia. Just over a half of cases reported symptoms after one dose of IV phenytoin. Pathologic findings included evidence for microvascular thrombosis and possible microvascular or subclinical extravasation as a contributing mechanism. Dopper ultrasound and conventional angiography were used in some patients to identify arterial or venous thrombosis. Various treatments were documented including the use of supportive care such as limb elevation and heat or cold application, utilization of systemic antibiotics, anticoagulants, or vasodilators, and local infiltration of hyaluronidase, heparin, or other compounds. In a small number of patients, invasive interventions such as regional anesthesia, thrombectomy, fasciotomy, and debridement were described. Time to resolution varied from days to weeks. Resolution of PGS without deficits was documented in the majority of cases. Skin changes followed by sensory and motor deficits were described in 16, 6, and 5 cases, respectively. Four patients underwent skin grafting and eight patients required limb amputation. Death as a result of PGS was documented in two patients. PGS associated with oral and injectable phenytoin or parenteral fosphenytoin has been documented in the literature and sometimes includes significant vascular thrombosis and potentially limbthreatening ischemia. Avoidance of small hand veins, adherence to recommended IV administration guidelines and monitoring of the infusion site for reactions should be considered to decrease the morbidity of IV phenytoin or fosphenytoin use. Patients with PGS and evidence of decreased distal perfusion should undergo prompt vascular imaging and potential intervention to avoid ischemic sequelae. Alternative anticonvulsant drugs should be considered in patients at risk for PGS when possible. hemorrhage, and secondary seizure disorder presented with partial left-sided motor seizure progressing to generalized tonic-clonic activity in the emergency department. After treatment with 4 mg of intravenous (IV) loraz...

show abstract

Section: Risk Factorsmentioning

confidence: 85%

Section: Review Of Reported Casesmentioning

confidence: 99%

Section: Review Of Reported Casesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Purple Glove Syndrome after Phenytoin or Fosphenytoin Administration: Review of Reported Cases and Recommendations for Prevention

2015

View full text Add to dashboard Cite

show abstract

“…Some factors thought to decrease the probability of PGS, all of which were adhered to in this patient's care, include the use of intravenous catheters smaller than 20-gauge, flushing with normal saline following intravenous administration, use of large-bore veins, and immediate discontinuation of the intravenous catheter upon symptom presentation. 6,7 Finally, oral drug should be used whenever possible. Though there has been a report of PGS with oral phenytoin use, 8 in this case the drug was given at larger doses than were indicated.…”

Section: Case Reportmentioning

confidence: 99%