Cadenbach A, Röttger K, Müller M K
Klinik für Kardiologie, Marienhospital Osnabrück.
Dtsch Med Wochenschr. 1998 Mar 13;123(11):318-22. doi: 10.1055/s-2007-1023967.
A 37-year-old woman, known since childhood to suffer from generalized seizures, was sent to the intensive care unit in status epilepticus. On admission tonic-clonic seizures persisted even after intravenously administration of clonazepam, 2 x 1 mg. She was unconscious and reacted unfocused to painful stimuli.
Further seizures occurred with vomiting and respiratory failure threatened. After intubation phenytoin was given intravenously (initially 250 mg over 10 min, then 750 mg over 24 h) into a vein on the dorsum of the hand. The seizures stopped. Within a few hours a livid swelling developed at the site of the needle puncture on the right hand, which spread to the lower arm (purple glove syndrome) and the patients could no longer move her arm because of pain. The condition improved with anti-inflammatory treatment and antibiotics as well as local measures. On discharge she was able to make a first without pain. However, she was re-admitted 3 weeks later because of renewed painful impairment of right hand movement and the picture of early Sudeck's atrophy. Under regional anaesthesia complete mobility and freedom from pain was achieved within 2 weeks.
Administration of phenytoin into a peripheral vein, especially of the hand, can cause soft tissue damage and should be avoided. Primarily the oral route is to be preferred.
一名37岁女性，自幼患有全身性癫痫，因癫痫持续状态被送往重症监护病房。入院时，即使静脉注射2毫克（2×1毫克）氯硝西泮后，强直阵挛性发作仍持续。她失去意识，对疼痛刺激反应不集中。
进一步发作时伴有呕吐，且有呼吸衰竭的危险。插管后，将苯妥英钠静脉注射（最初10分钟内注射250毫克，然后24小时内注射750毫克）到右手背静脉。癫痫发作停止。数小时内，右手穿刺部位出现青紫色肿胀，并蔓延至下臂（紫手套综合征），患者因疼痛无法移动手臂。经抗炎治疗、使用抗生素及采取局部措施后病情好转。出院时她能够无痛地进行首次活动。然而，3周后她因右手活动再次出现疼痛性障碍及早期苏戴克萎缩的表现而再次入院。在区域麻醉下，2周内恢复了完全活动能力且无痛。
将苯妥英钠注射到外周静脉，尤其是手部静脉，可导致软组织损伤，应避免使用。主要应首选口服途径。
