I’ve been a lawyer since 1997. There are some medical malpractice injuries that I’ve seen every week since then like death, failure to diagnose cancer, or surgical errors. While they may occur in different ways, it’s no surprise when a caller tells us that is what’s what happened. Other injuries are more unique or only now understood. One such potential medical malpractice lawsuit is purple glove syndrome.
Purple glove syndrome (PGS) is a minimally understood and uncommon skin disease where a patient’s limbs become discolored, painful, and swollen. PGS is most commonly reported among patients who have received intravenous (IV) doses of the drug phenytoin. It’s an anti-seizure medication also known as Dilantin. Phenytoin is only administered through an IV in emergency situations where the patient is having active seizures and is unable to receive medications orally.
Physicians believe that there are a few reasons for why PGS occurs, one being that a chemical irritation forms due to the high alkalinity of phenytoin and propylene glycol being administered. Further, they think that the mixing of alkaline solution and a neutral pH may led to a vascular and IV catheter obstruction. They also believe that the IV insertion may cause a microtear in the vessel wall that allows phenytoin to infiltrate the tissue without a way to exit. Microtears are more commonly seen in elderly patients which is why physician believe PGS is more common among their demographic.
PGS is characterized by a blueish-purple discoloration around the IV site accompanied with severe swelling and pain. The symptoms typically form within two to twelve hours of administration. Progression of PGS occurs in between twelve and sixteen hours where discoloration and swelling continues to spread throughout the whole limb.
There can be very mild and very severe cases of PGS. In the mild cases, physicians quickly recognize the symptoms and immediately discontinue the phenytoin IV, elevate the limb and/or apply heat/cold applications. Eventually the symptoms will subside, and the patient is healthy. In worst case scenarios, PGS can lead to necrosis, ischemia or vascular compression, any of which could lead to a need for amputation.
There are a few methods to reduce the likelihood of PGS which include education on various procedures. Phenytoin should not be administered at a rate greater than 50mg/min. Phenytoin, if diluted, should not be mixed immediately prior to administration. Dextrose solutions and lactated ringers’ solution cannot be used with a phenytoin IV. Avoid smaller veins especially in the hands. 20-guage catheters should be utilized, and arguably the most important, there should be careful and diligent monitoring of the IV site.
This is certainly not the most common case out there, but there are cases where patients are given this medication and not properly monitored. If you have purple glove syndrome and want to know if you may have a malpractice lawsuit, please contact us any time.