Digital gangrene after accidental intra-arterial injection of phenytoin (epanutin).

A case is described in which inadvertent intra-arterial injection of phenytoin led to digital gangrene, with arteriography showing occlusion of the digital arteries, necessitating amputation of fingers. The high alkalinity of phenytoin is strongly irritant to vessel walls. Intravenous injection of phenytoin should be given only with great care and in emergencies, preferably avoiding the cubital fossa.