Purple Glove Syndrome (PGS)
Incidence of PGS in Patients Receiving Intravenous Phenytoin
May 9, 2009
Purple glove syndrome (PGS) is a rare complication of intravenous phenytoin use that typically presents with pain, edema, and discoloration at the injection site that spreads to the distal limb. Several risk factors have been associated with the development of PGS; however, the cause remains unknown (Food & Drug Administration).
Purple Glove Syndrome starts as a pale blue or dark purple discoloration which appears around the intravenous insertion site 2 to 12 hours after the administration of the drug. Progression occurs during the next 12 to 16 hours as developing edema and continued discoloration spread around all sides of the affected limb.
Uses of Phenytoin
Phenytoin is an antiepileptic drug. Aside from seizures, it is an option in the treatment of trigeminal neuralgia as well as certain cardiac arrhythmias. In the US, phenytoin is marketed as Phenytek and Dilantin (including Dilantin Kapseals, Dilantin-125 and Dilantin Infatabs).
Phenytoin (PHT) has been widely used intravenously for the treatment of seizures since 1956, and for many years, it has been considered first-line therapy for status epilepticus. It is routinely administered intravenously in emergency departments and hospitals for patients who have had isolated seizures and for many patients undergoing neurosurgical procedures who are unable to receive oral medication.
A 1998 population study conducted by researchers at the Mayo Clinic found that of 152 patients receiving intravenous Dilantin (phenytoin), 9, or about 5.9%, developed Purple Glove Syndrome.
Adverse Effects of Phenytoin
Intravenous phenytoin has several well known adverse effects, such as hypotension, arrhythmias and toxicity. Purple glove syndrome is a less common complication that can have serious consequences. Fasciotomies, amputations and permanent disuse of the hand and forearm have been reported.
Three stages of purple glove syndrome have been identified: appearance, progression and resolution. During the second stage, progression, purple glove syndrome can be identified as either mild or severe. Mild cases may heal uneventfully when nursing measures such as elevation, application of dry, gentle heat and measures to prevent secondary injury are instituted. Severe cases may require emergency surgical intervention such as fasciotomy to relieve pressure and restore blood flow. Therapeutic nursing interventions aimed at maximizing healing and promoting comfort are essential.
If a patient is fortunate, the discoloration and edema will gradually fade, and the affected limb will heal within 2 to 4 weeks. However, Purple Glove Syndrome can sometimes turn quite serious, resulting in the death of affected tissue. When such necrosis occurs, a patient may require surgery to restore blood flow to the affected tissue. The most severe cases of Purple Glove Syndrome can lead to emergency surgery, and even limb amputation, if it becomes serious.
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