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Clinical Features and Management of Poisoning Due to Phenytoin

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  • Toxicology Management Review
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Summary

The widespread use of phenytoin results in frequent accidental and intentional toxicity. Metabolism is enzymatic and can be described by Michaelis-Menten kinetics. This results in an increased half-life in overdose situations and a protracted clinical course which may last a week or more. The primary toxicity is on the central nervous system. The most common initial finding in mild toxicity is nystagmus. As concentrations increase ataxia, decreased coordination, hyper-reflexia, slurred speech and diplopia may develop. Progressive increases result in confusion, lethargy and coma.

Various methods tried to increase elimination including dialysis, haemoperfusion, diuresis and plasmaphoresis have been ineffective and are not without risk. Meticulous supportive care including ventilation if necessary should provide a good clinical outcome. Multiple-dose activated charcoal may be helpful in shortening the duration of symptoms.

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Authors and Affiliations

  1. Emergency Medicine Residency, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA

    Johnny R. Larsen &  L. Scott Larsen

  2. Emergency Medical Services, Somerset Medical Center, Somerville, New Jersey, USA

    Johnny R. Larsen &  L. Scott Larsen

  3. Residency in Emergency Medicine, Morristown Memorial Hospital, Morristown, New Jersey, USA

    Johnny R. Larsen &  L. Scott Larsen

Authors
  1. Johnny R. Larsen
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  2. L. Scott Larsen
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Larsen, J.R., Larsen, L.S. Clinical Features and Management of Poisoning Due to Phenytoin. Med Toxicol Adverse Drug Exp 4, 229–245 (1989). https://doi.org/10.1007/BF03259910

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