Patient died from 8GMs of Dilantin

are there any drugs that you would give in that high of a dose?

Yes, that is true and it is hard to know what the unit set up is like in this ER. It is very sad for the patient, family and nurse. But 32 vials. That is unbelievable.

I am only a student and even I know that a pt would never get that much Dilantin, and I haven't even finished my Pharm class yet. That poor nurse. Something major was going on in her life that we aren't hearing about. Especially because the ER doc. got fired too. Why, what did he do wrong? This is strange and it really bothers me. It almost makes me it wasn't an accident, and I feel terrible even thinking that,but...... Another thought I had-maybe the R.N was in charge of the pt, and maybe a student nurse or medic was working with her made the mistake. That would still be an inexusable sitution because she would still be responsible; however I could almost see that happening instead. Hmmm. C'mon guys, figure this mystery out for this confused student nurse. This is really going to bug me.....

There are none for which you must draw up 32 vials. Our dilantin load vials are 250mg so I frequently have to open 3-6 at a time. And opening up even 3-6 vials of a med should be a red flag that has you checking all your bases thoroughly.

I can't think of any drug that I would give 8 grams of at a dose but I only give about 20 different drugs REGULARLY. Someone else may be able to think of some.

Could the Doc have written the order .8g instead of 0.8g and the nurse overlooked the little " . "????

Good point...

I remember helping an ICU nurse mix up a bagful of some drug to mix in fluid to make a continuous drip and we used about 10 or 15 vials of the drug. (why didn't pharmacy mix it? I don't even know...)

Could she have been thinking she was mixing up a continuous drip? Then maybe she made another error and set the IV drip rate too fast and infused it all in a short time?

Anyone that has ever looked up the side effects of dilantin iv (which should be anyone who has ever given it) would realize just how dangerous a normal dose is to give IV. I think alot of times we get so used to giving meds that we loose respect for them but we must remain vigilant. I have seen patients go aystole receiving a normal dose of dilantin iv. Yes it is tragic that this nurse gave far too much dilantin but if we are not careful it could also happen to us with a normal dose...I wish there was a safer way to give this drug or perhaps another drug that worked as well without as many side effects but until then we have to respect iv dilantin.

is this a case of malpractice for the doctor or negligence for both doc and nurse?

I think it would be a case of malpractice on the nurse's part, but if, as that last article said, she returned to her home country of Jamiaca, then hasn't she effectively avoided prosecution at this point? And if she was here on a visa, can they do anything to her legally? I don't know the first thing about work visas for nurses and what kinds of rules and regs go along with it. I hope that where ever she is, she stays out of nursing. And if she was under the influence of whatever, then she gets the help she needs.

Pam