Compartment syndrome as a spectrum of purple glove syndrome following intravenous phenytoin administration in a young male: A case report and review of literature

Chhabra, Puneet; Gupta, Nikhil; Kaushik, Atul

doi:10.4103/0028-3886.117611

Cited by 7 publications

(10 citation statements)

References 5 publications

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“…In terms of site, PGS is most commonly associated with upper extremities; however, it has been also reported in lower extremities and referred to as purple sock syndrome [13][14][15][16]. Bhattacharjee et al summarized the disease course into three temporal stages of injury: initial painful blue-purple discoloration and edema around the IV catheter site, subsequent worsening of pain, edema, and discoloration with development of epidermal sloughing, ulceration, or bullae formation, and neuromuscular symptoms such as paresthesias or weakness, and eventually resolution of edema and discoloration starting from the periphery of the injury and moving toward the site of catheter insertion [17].…”

Section: Purple Glove Syndrome: Pathophysiologymentioning

confidence: 99%

“…After review of the associated bibliographies, an additional 26 articles were found [4,13,16,20,21,23,27,29,30,32,33,35,36,38,39,41,42,[45][46][47][48][49][50][51][52][53][54]. In total, 72 patients experienced 82 cases of PGS following IV infusion of phenytoin described from 1984 to 2015.…”

Section: Review Of Reported Casesmentioning

confidence: 99%

“…Approximately one third (17/58, 29.3 %) of the PGS cases described dilution of phenytoin, with 14/17 (82.4 %) in normal saline for IV administration with diluent volumes ranging from 10 to 500 mL [13,15,16,19,29,34,35,38,40,45,46]. Two cases reported inadvertent dilution of phenytoin in plasmalyte and one in sterile water for injection, with both solutions not compatible with phenytoin [16,32].…”

Section: Review Of Reported Casesmentioning

confidence: 99%

“…On follow-up evaluation documented in 79 of 82 cases, fiftyfour (68.4 %) subjects demonstrated full recovery of function and appearance of the affected extremity. Of those reports that specified duration, resolution of symptoms occurred after a median of 14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) days. Sixteen (20.3 %) cases noted permanent skin changes without functional motor or sensory deficits.…”

Section: Review Of Reported Casesmentioning

confidence: 99%

“…Of the 12 cases of documented thrombosis, only 6 (50 %) made a complete recovery [4, 18, 27-32, 36, 45, 46]. Of the 6 additional cases where advanced imaging was employed but no clot was identified, 3 (50 %) recovered completely [13,35,38]. In comparison, of the remaining 64 % cases that did not report use of diagnostic imaging, 39 (63.8 %) cases reported a full recovery of symptoms.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

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

2015

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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...

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Section: Purple Glove Syndrome: Pathophysiologymentioning

confidence: 99%

Section: Review Of Reported Casesmentioning

confidence: 99%

Section: Review Of Reported Casesmentioning

confidence: 99%

Section: Review Of Reported Casesmentioning

confidence: 99%

Section: Diagnosis and Treatmentmentioning

confidence: 99%

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

2015

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Phenytoin, Valproat, Levetiracetam und Lacosamid im Status epilepticus

2018

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Pharmacotherapy for Status Epilepticus

Trinka

Höfler

Leitinger

et al. 2015

Drugs

180

148

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Status epilepticus (SE) represents the most severe form of epilepsy. It is one of the most common neurologic emergencies, with an incidence of up to 61 per 100,000 per year and an estimated mortality of 20 %. Clinically, tonic-clonic convulsive SE is divided into four subsequent stages: early, established, refractory, and super-refractory. Pharmacotherapy of status epilepticus, especially of its later stages, represents an “evidence-free zone,” due to a lack of high-quality, controlled trials to inform clinical decisions. This comprehensive narrative review focuses on the pharmacotherapy of SE, presented according to the four-staged approach outlined above, and providing pharmacological properties and efficacy/safety data for each antiepileptic drug according to the strength of scientific evidence from the available literature. Data sources included MEDLINE and back-tracking of references in pertinent studies. Intravenous lorazepam or intramuscular midazolam effectively control early SE in approximately 63–73 % of patients. Despite a suboptimal safety profile, intravenous phenytoin or phenobarbital are widely used treatments for established SE; alternatives include valproate, levetiracetam, and lacosamide. Anesthetics are widely used in refractory and super-refractory SE, despite the current lack of trials in this field. Data on alternative treatments in the later stages are limited. Valproate and levetiracetam represent safe and effective alternatives to phenobarbital and phenytoin for treatment of established SE persisting despite first-line treatment with benzodiazepines. To date there are no class I data to support recommendations for most antiepileptic drugs for established, refractory, and super-refractory SE. Limiting the methodologic heterogeneity across studies is required and high-class randomized, controlled trials to inform clinicians about the best treatment in established and refractory status are needed.

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Compartment syndrome as a spectrum of purple glove syndrome following intravenous phenytoin administration in a young male: A case report and review of literature

Cited by 7 publications

References 5 publications

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

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

Phenytoin, Valproat, Levetiracetam und Lacosamid im Status epilepticus

Pharmacotherapy for Status Epilepticus

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