title: Comparison of intraosseous versus intravenous loading of phenytoin in pigs and effect on bone marrow.
abstract: Much recent literature supports the resurgence of the intraosseous route of access in pediatrics. Intraosseous lines provide a timely noncollapsable route to the circulation in medical or traumatic emergencies when intravenous access is not possible. There has been no controlled study comparing intravenous and intraosseous loading of phenytoin. A 15 mg/kg dose of phenytoin was administered over 15 minutes to pigs by either the intravenous (n = 6) or tibial intraosseous route (n = 6). Femoral artery blood samples were drawn every 5 minutes for 35 minutes after initiation of infusion to determine phenytoin levels. There was no statistical difference between the two groups using analysis of variance repeated measures (P = .160). Microscopic examination of the cortex and marrow at the intraosseous site in these pigs was normal 5 weeks postinfusion. The authors conclude that the intraosseous route is an effective alternative to intravenous loading of phenytoin without permanent damage to the marrow.
authors.affiliation: Emergency Medicine Residency, Darnall Army Community Hospital, Ft Hood, TX 76544.
authors.forename: P J
authors.initials: PJ
authors.lastname: Vinsel
authors.forename: G P
authors.initials: GP
authors.lastname: Moore
authors.forename: K C
authors.initials: KC
authors.lastname: O'Hair
mesh_terms: D000818:Animals; D001853:Bone Marrow; D002648:Child; D002675:Child, Preschool; D004195:Disease Models, Animal; D004630:Emergencies; D006801:Humans; D007262:Infusions, Intravenous / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D007263:Infusions, Parenteral / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D010672:Phenytoin / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D013552:Swine
chemical_list: D010672:Phenytoin