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Presentations of acute phenytoin overdose
L B Mellick1, J A Morgan, G A Mellick
1Emergency Medicine Service, Tripler Army Medical Center, HI.
The American Journal of Emergency Medicine
|January 1, 1989
Summary
A massive phenytoin sodium overdose in a 15-year-old boy was survivable with supportive care. This case highlights the potential for recovery even with extremely high serum levels in acute anticonvulsant poisoning.
Area of Science:
- Pharmacology
- Toxicology
- Clinical Medicine
Background:
- Phenytoin is a widely used antiepileptic drug.
- Acute overdose can lead to significant toxicity.
- Understanding the clinical spectrum of phenytoin overdose is crucial for management.
Observation:
- A 15-year-old male ingested a large quantity of phenytoin sodium (19.6 g).
- The patient presented to the emergency department four hours post-ingestion.
- Peak serum phenytoin level reached 100.8 micrograms/mL.
Findings:
- The patient survived the massive overdose with only supportive care.
- A broad range of physical findings consistent with acute phenytoin toxicity were observed.
- This case, along with a literature review, helps define the presentation of acute phenytoin overdose.
Implications:
- Massive phenytoin overdose can be managed successfully with supportive measures.
- Clinical presentation of phenytoin toxicity can be diverse.
- This case contributes to the understanding of acute anticonvulsant poisoning management.