Abstracts

RATIONALE: Intravenous phenytoin was introduced for the treatment of seizures in 1956. For decades, it has been considered first line therapy for status epilepticus. It is routinely administered intravenously in emergency departments and hospitals for patients who have had isolated seizures and for many hospitalized patients who are unable to take oral phenytoin. Adverse reactions from phenytoin have been widely studied for years, but in the past deacde a new adverse reaction, the Purple Glove Syndrome (PGS), has been identified. The PGS is characterized by edema, discoloration and pain distally to the site of IV administration of phenytoin. Retrospective studies have reported this to be present in 5.9% of patients receiving phenytoin but there have been no prospective reports of the incidence of PGS. This is a blinded prospective study of the incidence of this syndrome. METHODS: 176 consecutive patients, who received intravenous phenytoin at Henry Ford Hospital, were enrolled. Distal portion of the upper extremities were examined by one of the authors (JGB), and digital pictures obtained from each patient, were blindly evaluated by the second author (GLB). Demographic and pertinent medical history was recorded for all patients, and outcome results for those who experienced PGS, were recorded. Associations between PGS and demographic and medical history information were assesed. RESULTS: Only two out of the 176 patients (1.1%), developed PGS. In both patients, the severity of the clinical picture was mild, and did not lengthen hospitalization, or required specialized treatment beyond local measures. CONCLUSIONS: The Purple Glove Syndrome is an infrequent, generally mild, complication of intravenous phenytoin infusion.