Related Experiment Video
Updated: Oct 20, 2025

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Phenytoin Pharmacokinetics During Venoarterial Extracorporeal Membrane Oxygenation and Plasma Exchange
Joseph C Osborne1, Caitlin S Brown2, Nathan D Peffley3
1Pharmacy/Clinical Pharmacist, Mayo Clinic, Rochester, USA.
Abstract:
Currently, there is minimal guidance to antiepileptic dose adjustment for a patient requiring either venoarterial (VA) extracorporeal membrane oxygenation (ECMO) or plasma exchange (PLEX) therapy, and to our knowledge, there are rare guidances for a patient requiring both. Given the dangers with non-therapeutic concentrations of phenytoin, it is critical for the intensive care unit (ICU) practitioner to understand how the pharmacokinetic parameters of phenytoin change in critically ill patients requiring extracorporeal support. This case study presents a 41-year-old female transferred to the cardiovascular ICU requiring VA ECMO and PLEX for the treatment of systemic lupus erythematosus (SLE)-induced catastrophic antiphospholipid syndrome (CAPS). Free phenytoin concentrations were measured to assess the removal of phenytoin. There was no significant decrease in the free phenytoin concentrations post-PLEX and while on ECMO. Free phenytoin concentrations are not influenced in the setting of PLEX and while on ECMO.
Related Concept Videos
Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy
Extracorporeal Removal of Drugs: Peritoneal Dialysis and Hemodialysis
Pharmacokinetics in Pediatric Patients: Drug Distribution
Extracorporeal Removal of Drugs: Hemoperfusion and Hemofiltration
Pharmacokinetics in Pediatric Patients: Drug Excretion
Dosage Regimens: Partial Pharmacokinetic Parameters

