Acute pulmonary disease caused by phenytoin

ABSTRACTS Peter Rosen, MD - - Editor

Frank J. Baker II, MD, FACEP - - Assistant Editor Associate Professor and Director Department of Emergency Medicine University of Chicago Hospitals and Clinics

Director

Division of Emergency Medicine Denver General Hospital

CARDIAC ARREST, PREHOSPITAL

Survivors of prehospitalization sudden death: characteristic clinical and angiographic features Tresch DD, Grove JR, Siegel R, et al Arch Intern Med 141:1154-1157

Aug 1981

Fifty-seven survivors of prehospitalization sudden cardiac death (PSD) underwent cardiac catheterization and angiography. These subjects represented a subset of 132 long-term survivors of PSD, long-term survivors being defined as patients discharged from the hospital alive who have returned to a level of independent function. Fifty-two of the subjects studied had anatomical coronary artery disease (CAD), with stenosis of the anterior descending coronary artery almost universal. Over half the patients with CAD had triple vessel disease. Over 95% of the patients with CAD had ventricular fibrillation as the initial documented arrhythmia. Angina, the most common antecedent symptom, was present in over half the patients with CAD; almost 50% of the patients with CAD were unaware of heart disease prior to PSD. Approximately one quarter (28%) of the patients studied sustained an acute MI. In general, the extent of CAD was less severe in patients with acute MI. The authors conclude that PSD is rare without anterior descending artery involvement, and hypothesize that in certain patients, acute ischemia without chronic ventricular dysfunction may be the cause of sudden cardiac arrhythmia death. The role of coronary artery spasm was undetermined. In general, the angiographic findings for survivors of PSD in this series corroborated the results of previous studies. Mont R. Roberts, MD

mic abnormality. Lung biopsies demonstrated an interstitial pneumonitis and angiitis. All abnormalities were reversed with cessation of the drug and treatment with corticosteroids. Phenytoin-induced pneumonitis is an unusual manifestation of the generalized hypersensitivity reaction to the

drug. [Editor's note: Considering the vast number of people taking this drug, it is surprising that this condition is not more frequently encountered.] William Jantsch, MD

PLACIDYL®; DRUG ABUSE, PLACIDYL®

Placidyl ® abuse: a dimorphic picture Schottstaedt M, Nicotra MB, Rivera M Crit Care Med 9:677-679

Sep 1981

Eleven patients with Placidyl ® (ethchlorvynol) overdose documented by urinary detection were reviewed retrospectively for clinical and laboratory abnormalities and hospital course. Seven patients had oral ingestion, three had IV overdose, and one had both. All patients with oral overdose presented in coma, and the length of coma did not correlate with dose. Those presenting after IV injection presented in pulmonary edema, and Swan-Ganz catheterization in one demonstrated a non-cardiogenic cause. Only one patient with oral overdose developed pulmonary edema, which occurred more than 40 hours after ingestion. Placidyl ® overdose presents with coma after oral ingestion or with pulmonary edema after IV injection. These syndromes are clearly separate from each other. Louis Ling, MD

PHENYTOIN; DRUG, ADVERSE REACTION, PHENYTOIN PULMONARY, DISEASE, PHENYTOIN

THORACIC VENTING, IN CARDIOPULMONARYRESUSCITATION; CARDIOPULMONARY RESUSCITATION,THORACIC VENTING

Acute pulmonary disease caused by phenytoin

Effect of thoracic venting on arterial pressure and flow during external cardiopulmonary resuscitation in animals

Michael JR, Rudin ML Ann Intern Med 95:452-454

Babbs CF, Bircher N, Burkett DE, et al Crit Care Med 9:785-789 Nov 1981

Oct 1981

Two patients are presented who developed fever, lymphadenopathy, dyspnea, hypoxemia, and diffuse interstitial and alveolar infiltrates on chest film soon after being placed on phenytoin sodium. These symptoms and findings were not due to any identifiable infectious, metabolic, or hemodyna11:12 December 1982

By comparing arterial pressure and flow before and after placement of bilateral chest tubes in dogs and pigs, the authors tested the hypothesis that blood flow occurs during CPR because of global intrathoracic pressure. The same

Annals of Emergency Medicine

704/93