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Hypoglycemia associated with phenytoin intoxication

M Manto1, J C Preiser, J L Vincent

  • 1Erasme University Hospital, Free University of Brussels, Belgium.

Journal of Toxicology. Clinical Toxicology
|January 1, 1996
PubMed
Summary
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Acute overdose of diphenylhydantoin (an antiepileptic) caused prolonged hypoglycemia, challenging its known hyperglycemia effect. This case highlights a rare adverse reaction to this common medication.

Area of Science:

  • Clinical Toxicology
  • Pharmacology

Background:

  • Diphenylhydantoin (phenytoin) is an antiepileptic drug known to affect carbohydrate metabolism.
  • Acute diphenylhydantoin intoxication is typically associated with hyperglycemia.

Observation:

  • A patient presented with a prolonged hypoglycemic episode following a massive voluntary overdose of diphenylhydantoin (20 g) and zopiclone (225 mg).

Findings:

  • The hypoglycemia was primarily attributed to diphenylhydantoin, suggesting a potential paradoxical effect.
  • Possible mechanisms include impaired insulin inhibition or increased tissue sensitivity to insulin by diphenylhydantoin.
  • Zopiclone was deemed less likely to be the cause due to its usual association with hyperglycemia in overdose cases.

Implications:

Related Experiment Videos

  • This case expands the known spectrum of diphenylhydantoin's metabolic effects, particularly in overdose scenarios.
  • Clinicians should consider hypoglycemia as a potential adverse effect of massive diphenylhydantoin intoxication.
  • Further research may clarify the mechanisms behind diphenylhydantoin-induced hypoglycemia.