Purple glove syndrome: Difference between revisions

Revision as of 13:10, 18 March 2025

Purple glove syndrome (PGS) is a rare but serious complication associated with the intravenous administration of the anticonvulsant drug phenytoin. It is characterized by the development of painful swelling, discoloration, and sometimes tissue necrosis in the affected limb.

Presentation

Purple glove syndrome typically presents within hours to days after the administration of phenytoin. The affected area, usually the hand or arm, initially shows a purple discoloration, which can progress to more severe symptoms including:

Pain and tenderness
Swelling
Blistering
Tissue necrosis

Pathophysiology

The exact mechanism of PGS is not well understood. However, it is believed to be related to the extravasation of phenytoin into the surrounding tissues, leading to local irritation and vascular damage. Factors that may contribute to the development of PGS include:

High pH of phenytoin solution
Rapid infusion rates
Use of small veins for administration

Diagnosis

Diagnosis of purple glove syndrome is primarily clinical, based on the characteristic appearance of the affected limb and the history of recent phenytoin administration. Imaging studies such as ultrasound or MRI may be used to assess the extent of tissue damage.

Management

Management of PGS involves discontinuation of phenytoin and supportive care. Treatment options may include:

Elevation of the affected limb
Application of warm compresses
Pain management with analgesics
Surgical intervention in severe cases, such as fasciotomy or debridement

Prevention

Preventive measures to reduce the risk of PGS include:

Using alternative routes of administration for phenytoin, such as oral or intramuscular
Administering phenytoin through a central venous catheter
Slowing the infusion rate and diluting the phenytoin solution

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