If you are experiencing issues, please log out of AAN.com and clear history and cookies. The mainstay of therapy for a patient with phenytoin intoxication is supportive care. Among 50 patients with phenytoin intoxication, 14 had seizures during the episode. Springer No comments have been published for this article. The free phenytoin fraction normally constitutes 10 percent of the plasma level. The only factor that seemed to correlate with seizures was a serum phenytoin level over 30 μg/ml. Phenytoin is extensively (90 percent) bound to plasma proteins, especially albumin. Phenytoin toxicity depends on the route of administration, duration, exposure, and dosage. 2019 May 25;393(10186):2125-2134. doi: 10.1016/S0140-6736(19)30724-X. This site needs JavaScript to work properly. Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death. Springer This article provides an overview of phenytoin pharmacokinetics and the clinical manifestations of toxicity, followed by a detailed review of the various treatment modalities. Unable to load your delegates due to an error Seizures in 9 of these 14 patients probably resulted from poor seizure control despite high phenytoin levels, but in 5 cases, attacks were attributed to phenytoin toxicity. There is no evidence that any invasive method of enhanced elimination (such as plasmapheresis, hemodialysis, or hemoperfusion) provides any benefit. Phenytoin has a small volume of distribution of 0.6 L/kg and is extensively bound to plasma proteins (90%). 'Royal Free Hospital'.This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. 2004 Aug;16(4):361-5. doi: 10.1111/j.1742-6723.2004.00629.x.Eyer F, Felgenhauer N, Pfab R, Thürmel K, Zilker T.Med Toxicol Adverse Drug Exp. No demographic, metabolic, neuropsychiatric, or therapeutic variables were predictive; nor were any other symptoms of toxicity particularly likely to be found in association with seizures. Epub 2019 Nov 26.Lyttle MD, Rainford NEA, Gamble C, Messahel S, Humphreys A, Hickey H, Woolfall K, Roper L, Noblet J, Lee ED, Potter S, Tate P, Iyer A, Evans V, Appleton RE; Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI) collaborative.Lancet. Please enable it to take advantage of the complete set of features! Intoxication manifests predominantly as nausea, central nervous system dysfunction (particularly confusion, nystagmus, and ataxia), with depressed conscious state, coma, and seizures occurring in more severe cases. (For instructions by browser, please click the instruction pages below). NOTE: The first author must also be the corresponding author of the comment.Your role and/or occupation, e.g. Seizures in 9 of these 14 patients probably resulted from poor seizure control despite high phenytoin levels, but in 5 cases, attacks were attributed to phenytoin toxicity. Orally administered phenytoin is rarely, if ever, associated with cardiac toxicity. Because of this the FDA has added a warning to the prescribing information for phenytoin that suggests cardiac monitoring occur during and after IV phenytoin administration. When you are returned to the Journal, your name should appear at the top right of the page.NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. 2018 Dec;97(51):e13689. There is no antidote, and there is no evidence that any method of gastrointestinal decontamination or enhanced elimination improves outcome. Cardiac complications such as arrhythmias and hypotension are rare in cases of phenytoin ingestion, but they may be seen in parenteral administration of phenytoin or fosphenytoin. After clearing, choose preferred Journal and select login for AAN Members. Hyzaar can cause fetal harm when administered to a pregnant woman. Deaths are unlikely after phenytoin intoxication alone. Experimental studies have proven increased clearance rates, but this effect has not been translated into clinical benefit. Name must be less than 100 characters Unable to load your collection due to an error Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations.