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Adverse events associated with intravenous phenytoin in children: a prospective study
Richard E Appleton1, Andrea Gill
1The Roald Dahl EEG Unit, Department of Neurology, Royal Liverpool Children's Hospital (Alder Hey), Liverpool, UK. richard.appleton@rlch-tr.nwest.nhs.uk
Insights
Intravenous phenytoin in children caused few adverse events like extravasation and hypotension, with all patients recovering fully. The study suggests infusion rates may influence side-effect occurrence.
Area of Science:
- Pediatric Pharmacology
- Clinical Pharmacy
- Drug Safety
Background:
- Intravenous phenytoin is used for pediatric seizure management.
- Understanding its adverse effects in children is crucial for safe administration.
Purpose of the Study:
- To evaluate the incidence and types of adverse side effects associated with intravenous phenytoin in pediatric patients.
- To identify potential risk factors for adverse events.
Main Methods:
- A prospective study involving 22 pediatric patients.
- 100 doses of intravenous phenytoin were administered over 10 months.
- Adverse events were monitored and recorded.
Main Results:
- 27% of patients (6 out of 22) experienced adverse effects.
- Observed side effects included extravasation, hypotension, and cardiac arrhythmia.
- No cases of skin necrosis or 'purple glove syndrome' were reported.
- All side effects resolved spontaneously and completely.
Conclusions:
- Intravenous phenytoin appears to have a manageable side effect profile in children.
- Excessive infusion rates or saline flushes may contribute to adverse events.
- The overall frequency of side effects was lower than anticipated.
Abstract:
A prospective study was undertaken to assess the type and frequency of adverse side-effects following the use of intravenous phenytoin in children. Twenty-two children received a total of 100 doses over a 10-month period. Six patients (27%) experienced one or more side-effects, including extravasation of the drug, hypotension and cardiac arrhythmia. No patient developed skin necrosis, including the 'purple glove syndrome'. Recovery from all adverse side-effects was spontaneous and complete. It is possible that some or all of these side-effects may have been caused by an excessive rate of infusion of phenytoin or the saline 'flush' following administration of the drug. The overall frequency of side-effects was perhaps less than expected.