Phenytoin administration by constant intravenous infusion: selective rates of administration.
OBJECTIVE
To determine the adequacy of seizure control and the adverse effects of administering an IV loading dose of phenytoin by constant infusion pump.


METHODS
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.


METHODS
A rural community hospital emergency department.


METHODS
Forty-two adult patients.


METHODS
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.


RESULTS
Group 2 demonstrated significantly more cardiovascular side effects (hypotension and bradycardia) than did group 1 (Fisher's exact test, P less than .05).


CONCLUSIONS
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.
Donovan
P J
PJ
Department of Emergency Service, North Adams Regional Hospital, Massachusetts 01247.
Cline
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000150:complications; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000150:complications; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D012640:Seizures / Q000150:complications / Q000188:drug therapy*; D013226:Status Epilepticus / Q000150:complications / Q000188:drug therapy*
D010672:Phenytoin