Pearls & Oy-sters: Soft-tissue necrosis as a result of intravenous leakage of phenytoin

1. Phenytoin leakage can cause potentially serious side effects ranging from mild edema to soft-tissue necrosis. 2. To avoid such events, one should consider using: 1. a dedicated IV catheter inserted in a large peripheral vein to infuse phenytoin; 2. administration rate ≤50 mg/min; 3. periodic flushing with saline after each bolus; 4. continuous monitoring for signs of extravasation, hypotension, and bradycardia. 3. The ease of administration, rapid onset of action, minimal morbidity, and IV solution compatibility are potential advantages of some of the second-line anticonvulsant agents, like valproate. In the past 70 years, phenytoin (PHT) has been used in the management of seizures and remains, despite the advent of newer antiepileptic drugs,1 one of the preferred long-acting antiepileptic drugs in the treatment of convulsive status epilepticus.2 Injury due to PHT leakage may result in damage ranging from simple, mild phlebitis to severe lesions such as soft tissue necrosis.3,4 Up to 20% of IV administration of all drugs results in recognized episodes of extravasation.5 Nevertheless, few studies address the adverse events associated with the IV use of PHT.2,6 Factors believed to affect the extent of injury include the …