PGS

 Q: The risk of purple glove syndrome (PGS) due to phenytoin is _____________ by administering it via central line? (select one)

A) decreased

B) increased

Answer: A

The pathogenesis of purple glove syndrome is very poorly understood. It occurs only with intravenous infusions (though one case has been reported with oral ingestion 5), which gives the presumption that it may be related to leakage into soft tissue. This is further confirmed by the fact that arterial dopplers usually stays normal, and symptoms occur only on the arm receiving phenytoin. 

Associated symptoms are edema, blistering, pain, and purple discoloration. Histopathology shows superficial venous thrombosis. Due to its association only with intravenous form, it is proposed that actual culprits are added preservatives i.e., propylene glycol and sodium hydroxide.

#toxicology

#pharmacology

References:

1. O'Brien TJ, Cascino GD, So EL, Hanna DR. Incidence and clinical consequence of the purple glove syndrome in patients receiving intravenous phenytoin. Neurology 1998; 51:1034. 

2. Santoshi JA, Justin AS, Jacob JI, et al. Purple glove syndrome: a case report. Hand surgeons and physicians be aware. J Plast Reconstr Aesthet Surg 2010; 63:e340. 

3. Chokshi R, Openshaw J, Mehta NN, Mohler E 3rd. Purple glove syndrome following intravenous phenytoin administration. Vasc Med 2007; 12:29. 

4. Bhattacharjee P, Glusac EJ. Early histopathologic changes in purple glove syndrome. J Cutan Pathol 2004; 31:513. 

5. Yoshikawa H, Abe T, Oda Y. Purple glove syndrome caused by oral administration of phenytoin. J Child Neurol 2000; 15:762.