Neurological Disorders Q 35 - Gyan Darpan : Learning Portal
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Tuesday, 19 April 2022

Neurological Disorders Q 35

A client with a subarachnoid hemorrhage is prescribed a 1,000-mg loading dose of Dilantin IV. Which consideration is most important when administering this dose?
     A. Therapeutic drug levels should be maintained between 20 to 30 mg/ml.
     B. Rapid Dilantin administration can cause cardiac arrhythmias.
     C. Dilantin should be mixed in dextrose in water before administration.
     D. Dilantin should be administered through an IV catheter in the client’s hand.

Correct Answer: B. Rapid Dilantin administration can cause cardiac arrhythmias.

Dilantin IV shouldn’t be given at a rate exceeding 50 mg/minute. Rapid administration can depress the myocardium, causing arrhythmias. The drug is slowly administered intravenously directly into a large central or peripheral vein through an IV catheter less than 20 gauge, not exceeding a rate of 50 mg/minute.

Option A: Therapeutic drug levels range from 10 to 20 mg/ml. Phenytoin displays its primary signs of toxicity on the nervous and cardiovascular systems. Overdose on oral phenytoin mainly causes neurotoxicity, whereas cardiovascular toxicity is the main side effect of parenteral administration.
Option C: Dilantin shouldn’t be mixed in solution for administration. However, because it’s compatible with normal saline solution, it can be injected through an IV line containing normal saline. It requires dilution with sodium chloride. Crystals will form when diluted with dextrose solution.
Option D: When given through an IV catheter hand, Dilantin may cause purple glove syndrome. “Purple glove syndrome” is a rare side effect that can accompany the intravenous administration of phenytoin. The worsening limb edema and discoloration appear to result from the crystallization of phenytoin within the blood. When there are extensive skin necrosis and limb ischemia, this can lead to amputations.

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