To the Editor.—In reply to the article, "Severe Soft-Tissue Injury Following Intravenous Infusion of Phenytoin" that appeared in the June 1988 issue of the Archives,1 I would consider that the toxic effects of intravenous phenytoin are not due primarily to the drug itself, but largely from the diluent, propylene glycol. This was only mildly implied in the article (page 1332).
A patient who required intravenous phenytoin therapy was seen recently in the hospital. Immediately after satisfactory injection in the appropriate piggyback manner, as recommended,2 the injection was administered into a vein on the dorsum of the hand. A socalled "purple hand" followed, and the hand became gangrenous. Subsequently, the patient died.
The toxicity of propylene glycol is well known, and was incriminated in a recent article entitled "Dangers From Methylprednisolone Acetate Therapy by Intraspinal Injection."3 The toxicity of propylene glycol in the spinal canal was