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Sept 11, 1967

Diphenylhydantoin Toxicity

JAMA. 1967;201(11):894. doi:10.1001/jama.1967.03130110120047

To the Editor:—  Two articles "Fatalities Following Intravenous Use of Sodium Diphenylhydantoin for Cardiac Arrhythmias" and "Fatal Ventricular Fibrillation Following Intravenous Sodium Diphenylhydantoin Therapy" (200:335-338, 1967) incriminate diphenylhydantoin sodium as the causative factor in the death of three patients.The three patients reported in the two articles were all rapidly deteriorating clinically despite intensive medical treatment at the time of diphenylhydantoin administration. In this setting, the incrimination of diphenylhydantoin as the causative factor in the death of at least two of these patients is questionable. In the initial report both patients had pulmonary edema, one with falling blood pressure. The third patient was semiconscious with sepsis and hypoxia. It would have been important to indicate the blood pressure during and after the diphenylhydantoin infusion since this is an important determinant of the rate of the drug's administration.In contrast to these three cases, a substantial clinical experience has been

Rosen, M.R.; Lisa, K.R.; and Rubin, I.L.:  Diphenylhydantoin in Cardiac Arrhythmias ,  Circulation 34 ( (suppl 3) ): 201, 1966.
Karliner, J.:  Intravenous Diphenylhydantoin Sodium (Dilantin) in Cardiac Arrhythmias ,  Dis Chest 51:256, 1967.Crossref
Bigger, J.; Schmidt, D.; and Kutt, H.:  The Relationship Between the Antiarrhythmic Effect and the Plasma Level of Diphenylhydantoin Sodium (Dilantin) ,  Proc New York Acad Sci 42:1039, 1966.
Osborne, J.:  Diphenylhydantoin in the Treatment of Clinical Arrhythmias ,  Amer J Cardiol 13:126, 1964.Crossref
Helfant, R.; Scherlag, B.; and Damato, A.:  The Electrophysiological Properties of Diphenylhydantoin Sodium (Dilantin) in the Normal and Digitalis Intoxicated Heart ,  Circulation , to be published.