Donovan P J, Cline D
Department of Emergency Service, North Adams Regional Hospital, Massachusetts 01247.
Ann Emerg Med. 1991 Feb;20(2):139-42. doi: 10.1016/s0196-0644(05)81211-9.
To determine the adequacy of seizure control and the adverse effects of administering an IV loading dose of phenytoin by constant infusion pump.
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.
A rural community hospital emergency department.
Forty-two adult patients.
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.
Group 2 demonstrated significantly more cardiovascular side effects (hypotension and bradycardia) than did group 1 (Fisher's exact test, P less than .05).
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.
