Complications of intravenous phenytoin for acute treatment of seizures. Recommendations for usage
M. P. Earnest, J. A. Marx and L. R. Drury
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.
