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Phenytoin intoxication in critically ill patients.

Gert De Schoenmakere¹, Jan De Waele, Wim Terryn

¹Department of Intensive Care, University Hospital, Gent, Belgium. Gert.Deschoenmakere@skynet.be

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation

|February 8, 2005

Summary

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Phenytoin overdose can cause severe disorders due to saturated hepatic clearance. Combining high-flux dialysis with hemoperfusion effectively removed the drug, improving patient outcomes.

Area of Science:

Pharmacology
Toxicology
Nephrology

Background:

Phenytoin intoxication presents a clinical challenge due to saturated hepatic clearance and zero-order kinetics, leading to slow drug elimination.
Limited treatment options exist for phenytoin overdose, complicated by its high protein binding, which hinders extracorporeal removal.
Hemoperfusion is a commonly employed technique for phenytoin elimination, though its efficacy can be enhanced.

Observation:

A case study involved a hypoalbuminemic patient with severe neurological symptoms from phenytoin intoxication.
The patient presented with moderately elevated total phenytoin concentration but a high free fraction.
This clinical scenario highlighted the importance of considering free drug levels in managing intoxication.

Findings:

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A combined approach of high-flux dialysis and hemoperfusion was implemented for the patient.
This combined therapy resulted in significant phenytoin extraction from the body.
Clinical signs of intoxication demonstrably improved following the intervention.

Implications:

High-flux dialysis, particularly in patients with a high free fraction of phenytoin, can be a valuable addition to hemoperfusion.
This therapeutic strategy may accelerate drug clearance and mitigate severe intoxication symptoms.
Further research into combined extracorporeal techniques for phenytoin overdose is warranted.