Presentations of acute phenytoin overdose

A 15-year-old boy ingested 19.6 g (15 g verifiable) phenytoin sodium approximately four hours before emergency department presentation. The patient survived the suicide attempt with only supportive care, despite the ingestion of 392 mg/kg and a peak serum level of 100.8 micrograms/mL. A wide spectrum of physical findings consistent with acute massive ingestion of phenytoin was noted. This case report and a review of cases reported in the English literature of acute single anticonvulsant ingestion further delineate the clinical presentation of acute phenytoin overdose.