Friday, December 14, 2007

Friday December 14, 2007
Phenytoin induced Purple glove syndrome



Purple glove syndrome also known as PGS is a progressive distal limb edema, discoloration, and pain after peripheral administration of phenytoin. If unrecognised, it may lead to severe skin necrosis, limb ischemia and to compartment syndromes. It is a fairly unknown and under diagnosed complication with IV Phenytoin and reported in upto 5% of cases. It is mostly overlooked due to reflexly made diagnosis of cellulitis at IV site.


Mechanism of action: 2 probable mechanisms has been described.


1. Phenytoin is poorly soluble at neutral PH. Solutions like sodium hydroxide, propylene glycol and ethanol are added to enhance solubility by increasing PH. Highly alkaline solution may induce vasoconstriction and thrombosis in vessels – may allow leakage into interstitial space.


2. Mixing of alkaline phenytoin solution with blood induce precip. of phenytoin crystals, leading to obstruction of micro vessels causing ischemia and also may induce leakage.


Treatment : is mostly supportive with elevation of limb, compression, dry, gentle heat, galvanic stimulation and in severe cases fasciotomy, skin grafting or amputation.




Refrences: click to get abstract/article

1. Incidence and clinical consequences of purple glove syndrome in patients receiving intravenous phenytoin, Neurology, 1998:51:1034-1039.
2.
A prospective study of the purple glove syndrome , Epilepsia, 2001:42(9):1156-1159.
3. Purple glove syndrome : A complication of intravenous phenytoin, J. of Neuroscience Nursing, 1992:24(8):340-345.
4.
Purple glove syndrome: a complication of intravenous phenytoin. - J Neurosci Nurs.1992 Dec;24(6):340-5

1 comment:

Unknown said...

Would like to use this picture for a project. Is this original with you or has been published in one of your cited sources?