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Phenytoin administration by constant intravenous infusion: selective rates of administration
1Department of Emergency Service, North Adams Regional Hospital, Massachusetts 01247.
Insights
Intravenous phenytoin effectively controls seizures. However, patients with atherosclerotic cardiovascular disease (ASCVD) experienced more side effects when given phenytoin at 50 mg/min compared to younger patients without ASCVD.
Area of Science:
- Neurology
- Clinical Pharmacology
- Emergency Medicine
Background:
- Status epilepticus requires prompt treatment with antiepileptic drugs.
- Intravenous phenytoin is a common choice for seizure management.
- Infusion rates may influence adverse cardiovascular events.
Purpose of the Study:
- To assess seizure control with IV phenytoin loading doses.
- To evaluate cardiovascular adverse effects of phenytoin infusion.
- To compare safety in patients with and without atherosclerotic cardiovascular disease (ASCVD).
Main Methods:
- Prospective study of 42 adult patients with acute seizures.
- Two groups: Group 1 (≤50 yrs, no ASCVD), Group 2 (>50 yrs or with ASCVD).
- Phenytoin loading dose (15 mg/kg) infused at 50 mg/min (Group 1) or 25 mg/min (Group 2); cardiac monitoring.
Main Results:
- Phenytoin achieved adequate seizure control in both groups.
- Group 2 experienced significantly more cardiovascular side effects (hypotension, bradycardia) than Group 1 (P < .05).
Conclusions:
- IV phenytoin is effective for seizure control.
- Infusion rate of 25 mg/min is recommended for patients with ASCVD.
- Infusion rate of 50 mg/min appears safe for patients without ASCVD.
Study Objectives:
To determine the adequacy of seizure control and the adverse effects of administering an IV loading dose of phenytoin by constant infusion pump.
Design:
A prospective study of patients presenting with acute onset of seizures. Patients were divided into two groups. Group 1 comprised all patients 50 years of age or younger without a history of atherosclerotic cardiovascular disease (ASCVD). Group 2 comprised all patients older than 50 years or with a history of ASCVD.
Setting:
A rural community hospital emergency department.
Type Of Participants:
Forty-two adult patients.
Interventions:
Both groups received an IV loading dose of phenytoin at 15 mg/kg. Infusion rates were 50 mg/min and 25 mg/min for groups 1 and 2, respectively. Cardiac rhythm and vital signs were monitored throughout and after infusion.
Measures And Main Results:
Group 2 demonstrated significantly more cardiovascular side effects (hypotension and bradycardia) than did group 1 (Fisher's exact test, P less than .05).
Conclusion:
Phenytoin provided adequate seizure control in both groups. For individuals with ASCVD, IV phenytoin administration rates should not exceed 25 mg/min. For individuals without ASCVD, phenytoin administration at 50 mg/min appears safe and without significant cardiovascular side effects.