From the Research
Purple glove syndrome management primarily involves supportive care and close monitoring, with initial treatment focusing on discontinuing phenytoin and switching to alternative anticonvulsants like levetiracetam or valproate. The condition is characterized by pain, edema, and purple-blue discoloration of the limb distal to the site of injection, often due to phenytoin's high alkalinity causing extravasation and local tissue injury 1. Key aspects of management include:
- Elevating the affected limb to reduce swelling
- Applying warm compresses to improve circulation
- Pain management with analgesics such as acetaminophen or NSAIDs
- In severe cases, surgical consultation for compartment syndrome assessment, potentially requiring fasciotomy if compartment pressures exceed 30 mmHg or if there's significant neurovascular compromise 2, 3 Prevention is crucial, using slower infusion rates (maximum 50 mg/min) of phenytoin, adequate dilution in saline, and avoiding small peripheral veins 1. A continuous blockade of the brachial plexus with a low concentration of bupivacaine and fentanyl may also help alleviate vasospasm and pain while preserving motor function 4. Most cases resolve spontaneously within 2-3 weeks with conservative management, though severe cases may result in tissue necrosis or permanent nerve damage, highlighting the importance of prompt recognition and intervention 2, 3, 1.