Monday December 17, 2007
Re. Purple Glove Syndrome

Here are few responses re. our pearl from 2 days back, Phenytoin induced Purple glove syndrome


1) "I've given a lot of phenytoin over the years and I've never seen this. Neither have most of the people I know. The Mayo epilepsy group are are very good, and I don't discount what they have written (upto 5.9% *) but it seems unusual that no one else seems to see it more often than once in a blue moon. I have seen bad extravasations, which is more likely the cause of the problem. And, the crystallization of phenytoin in microvessels makes no sense as an explanation of a local complication for a drug being given intravenously.

Disclaimer: Much of the phenytoin I've given has been through a central line, where this wouldn't be an issue ".

* (Ref. # 1 in said pearl: Incidence and clinical consequences of purple glove syndrome in patients receiving intravenous phenytoin, Neurology, 1998:51:1034-1039),


Thomas P. Bleck MD FCCM
Ruggles Chairman of Neurology, Evanston Northwestern Healthcare;
Vice Chair for Academic Programs, Department of Neurology, and
Professor of Neurology, Neurological Surgery, and Medicine,
Northwestern University Feinberg School of Medicine
Founding Past President, The Neurocritical Care Society(http://www.neurocriticalcare.org)



2) "It must be once in a blue moon, as I have witnessed this only twice during my practice. Please check out the link below

Photo Quiz - Distal Upper Extremity Edema and Discoloration

Surindra J. Singh, M.D., Intensivist, VAMC, Salem, VA 24153 Surindra.Singh@va.gov




3) "This is well described with thiopentone and other drugs which is worsened by inadvertent intra-arterial injection.(Intravenous injection is followed by secondary arterial spasm) Things to do is heparinization. IV /intrarterial lignocaine and a symptathetic blockade by an axillary block to relieve reflex vsasopspasm. The one thing NOT to do is remove the intrarterial line if this happens due to inadvertent intrarterial injection. immediately inject any vasodilator like nitroglycerine or nitroprusside, heparin and papaverine diluted in blood through the line. If the line is removed intrarterial accesss will be lost. Many a time so called intravenous access is actually due to an intrarterial placement of a variant branch of the radial arterywhich being a smaller brach does not give a very good arterial flashback.This is well described in the 1960's by Bailey in his textbook of emergency surgery. A point well to be learnt from a historical textbook that has a lot of home truths which are true even today".

"Prasanna Simha M" , prasannasimha@gmail.com