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February 11, 1983, Vol 249, No. 6 >
ARTICLE | February 11, 1983

Complications of Intravenous Phenytoin for Acute Treatment of Seizures: Title and subTitle BreakRecommendations for Usage FREE

Michael P. Earnest, MD; John A. Marx, MD; Lawrence R. Drury, MD
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JAMA. 1983;249(6):762-765. doi:10.1001/jama.1983.03330300046032
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References

Intravenous (IV) phenytoin sodium in small volumes of normal saline was administered in a municipal hospital emergency department for treatment of convulsions in 200 patients. A total of 72 complications developed in 51 patients. Twenty-nine complications were burning pain at the IV site, and 36 were related to excessive total dose of phenytoin and resultant drug intoxication. Seven other patients had cardiovascular complications, including hypotension and arrhythmias. These seven complications were related to high concentrations of drug administered at a rapid rate. Both the IV and cardiovascular complications promptly resolved when the IV rate was slowed or temporarily stopped. No patient died, and none was hospitalized because of a complication. The authors propose specific guidelines for the safe administration of IV phenytoin.

(JAMA 1983;249:762-765)

REFERENCES

1 +
Murphy JT, Schwab RS:  Diphenylhydantoin (Dilantin) sodium used parenterally in control of convulsions . JAMA 1956;;160:385-388.
2 +
Carter CH:  Use of parenteral diphenylhydantoin (Dilantin) sodium in control of status epilepticus . Arch Neurol Psychiatr 1958;;79:136-137.
3 +
McWilliam PKA:  Intravenous phenytoin sodium in continuous convulsions in children . Lancet 1958;;2:1147-1149.
4 +
Buchthal F, Svensmark O, Schiller PJ:  Clinical and electroencephalographic correlations with serum levels of diphenylhydantoin . Arch Neurol 1960;;2:624-630.
5 +
Wallis W, Kutt H, McDowell F:  Intravenous diphenylhydantoin in treatment of acute repetitive seizures . Neurology 1968;;18:513-525.
6 +
Wilder BJ, Ramsay E, Willmore LJ, et al:  Efficacy of intravenous phenytoin in the treatment of status epilepticus: Kinetics of central nervous system penetration . Ann Neurol 1977;; 1:511-518.
7 +
Cranford R, Leppik IE, Patrick B, et al:  Intravenous phenytoin: Clinical and pharmacokinetic aspects . Neurology 1978;;28:874-880.
8 +
Cranford R, Leppik IE, Patrick B, et al:  Intravenous phenytoin in acute treatment of seizures . Neurology 1979;;29:1474-1479.
9 +
Wilder BJ, Bruni J: Seizure Disorder—A Pharmacological Approach to Treatment . New York, Raven Press, 1981;, pp 69-74.
10 +
Goldschlager AW, Karliner JS:  Ventricular standstill after intravenous diphenylhydantoin . Am Heart J 1967;;74:410-412.
11 +
Louis S, Kutt H, McDowell F:  The cardiocirculatory changes caused by intravenous Dilantin and its solvent . Am Heart J 1967;; 74:523-529.
12 +
Unger AH, Sklaroff HJ:  Fatalities following intravenous use of sodium diphenylhydantoin for cardiac arrhythmias: Report of two cases . JAMA 1967;;200:335-336.
13 +
Russell MA, Bousvaros G:  Fatal results from diphenylhydantoin administered intravenously . JAMA 1968;;206:2118-2119.
14 +
Zoneraich S, Zoneraich O, Siegel J:  Sudden death following intravenous sodium diphenylhydantoin . Am Heart J 1976;;91:375-377.
15 +
Barron SA:  Cardiac arrhythmias after small IV dose of phenytoin . N Engl J Med 1976;;295:678.
16 +
Sachtler G, Tobias DC, Kellick KA, et al:  Five letters to the editor concerning studies of crystallization of phenytoin in IV solutions . Drug Intell Clin Pharm 1973;;7:418-419.
17 +
Bauman JL, Siepler JK, Fitzloff J:  Phenytoin crystallization in intravenous fluids . Drug Intell Clin Pharm 1977;;11:646-649.
18 +
Greenblatt DJ, Shader RI:  Intravenous phenytoin . N Engl J Med 1976;;295:1078.
19 +
Bauman JL, Siepler JK, Schondelmeyer S:  Intravenous phenytoin (concluded) . N Engl J Med 1977;;296:111.
20 +
Cloyd JC, Bosch DE, Sawchuk RJ:  Concentration-time profile of phenytoin after admixture with small volumes of intravenous fluids . Am J Hosp Pharm 1978;;35:45-48.
21 +
Salem RB, Yost RL, Torosian G, et al:  Investigation of the crystallization of phenytoin in normal saline . Drug Intell Clin Pharm 1980;; 14:605-608.
22 +
Salem RG, Wilder BJ, Yost RL, et al:  Rapid infusion of phenytoin sodium loading doses . Am J Hosp Pharm 1981;;38:354-357.

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1 +
Murphy JT, Schwab RS:  Diphenylhydantoin (Dilantin) sodium used parenterally in control of convulsions . JAMA 1956;;160:385-388.
2 +
Carter CH:  Use of parenteral diphenylhydantoin (Dilantin) sodium in control of status epilepticus . Arch Neurol Psychiatr 1958;;79:136-137.
3 +
McWilliam PKA:  Intravenous phenytoin sodium in continuous convulsions in children . Lancet 1958;;2:1147-1149.
4 +
Buchthal F, Svensmark O, Schiller PJ:  Clinical and electroencephalographic correlations with serum levels of diphenylhydantoin . Arch Neurol 1960;;2:624-630.
5 +
Wallis W, Kutt H, McDowell F:  Intravenous diphenylhydantoin in treatment of acute repetitive seizures . Neurology 1968;;18:513-525.
6 +
Wilder BJ, Ramsay E, Willmore LJ, et al:  Efficacy of intravenous phenytoin in the treatment of status epilepticus: Kinetics of central nervous system penetration . Ann Neurol 1977;; 1:511-518.
7 +
Cranford R, Leppik IE, Patrick B, et al:  Intravenous phenytoin: Clinical and pharmacokinetic aspects . Neurology 1978;;28:874-880.
8 +
Cranford R, Leppik IE, Patrick B, et al:  Intravenous phenytoin in acute treatment of seizures . Neurology 1979;;29:1474-1479.
9 +
Wilder BJ, Bruni J: Seizure Disorder—A Pharmacological Approach to Treatment . New York, Raven Press, 1981;, pp 69-74.
10 +
Goldschlager AW, Karliner JS:  Ventricular standstill after intravenous diphenylhydantoin . Am Heart J 1967;;74:410-412.
11 +
Louis S, Kutt H, McDowell F:  The cardiocirculatory changes caused by intravenous Dilantin and its solvent . Am Heart J 1967;; 74:523-529.
12 +
Unger AH, Sklaroff HJ:  Fatalities following intravenous use of sodium diphenylhydantoin for cardiac arrhythmias: Report of two cases . JAMA 1967;;200:335-336.
13 +
Russell MA, Bousvaros G:  Fatal results from diphenylhydantoin administered intravenously . JAMA 1968;;206:2118-2119.
14 +
Zoneraich S, Zoneraich O, Siegel J:  Sudden death following intravenous sodium diphenylhydantoin . Am Heart J 1976;;91:375-377.
15 +
Barron SA:  Cardiac arrhythmias after small IV dose of phenytoin . N Engl J Med 1976;;295:678.
16 +
Sachtler G, Tobias DC, Kellick KA, et al:  Five letters to the editor concerning studies of crystallization of phenytoin in IV solutions . Drug Intell Clin Pharm 1973;;7:418-419.
17 +
Bauman JL, Siepler JK, Fitzloff J:  Phenytoin crystallization in intravenous fluids . Drug Intell Clin Pharm 1977;;11:646-649.
18 +
Greenblatt DJ, Shader RI:  Intravenous phenytoin . N Engl J Med 1976;;295:1078.
19 +
Bauman JL, Siepler JK, Schondelmeyer S:  Intravenous phenytoin (concluded) . N Engl J Med 1977;;296:111.
20 +
Cloyd JC, Bosch DE, Sawchuk RJ:  Concentration-time profile of phenytoin after admixture with small volumes of intravenous fluids . Am J Hosp Pharm 1978;;35:45-48.
21 +
Salem RB, Yost RL, Torosian G, et al:  Investigation of the crystallization of phenytoin in normal saline . Drug Intell Clin Pharm 1980;; 14:605-608.
22 +
Salem RG, Wilder BJ, Yost RL, et al:  Rapid infusion of phenytoin sodium loading doses . Am J Hosp Pharm 1981;;38:354-357.

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