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Phenytoin toxicity presenting as acute meningo-encephalitis in children

Vijay Gupta1, Tribhuvan P Yadav, Anita Yadav

  • 1Department of Pediatrics and Neonatology, PGIMER and Associated Dr. Ram Manohar Lohia Hospital, New Delhi, India. yzaygupta@gmail.com

Neurology India
|February 23, 2011
PubMed

Insights

Phenytoin toxicity can mimic serious infections in children, especially when serum levels cannot be measured. Recognizing these symptoms is crucial for prompt diagnosis and management in pediatric emergency settings.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Toxicology
  • Neuropharmacology

Background:

  • Phenytoin is an anticonvulsant medication with a narrow therapeutic index.
  • Zero-order pharmacokinetics of phenytoin can lead to dose-related toxicity.
  • Differentiating phenytoin toxicity from other acute neurological conditions is clinically significant.

Observation:

  • Two pediatric cases presented to the emergency department with symptoms mimicking acute meningo-encephalitis.
  • Symptoms included fever, vomiting, seizures, and ataxia.
  • These signs can be mistaken for infectious meningo-encephalitis.

Findings:

  • The patients exhibited signs and symptoms consistent with phenytoin toxicity.
  • The presentation mimicked acute meningo-encephalitis, posing a diagnostic challenge.
  • Lack of readily available serum phenytoin level monitoring complicates diagnosis.

Implications:

  • Early recognition of phenytoin toxicity is vital in pediatric emergency medicine.
  • Clinicians should consider phenytoin toxicity in children presenting with meningo-encephalitis-like symptoms.
  • This highlights the importance of considering iatrogenic causes of neurological symptoms in children.

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