RT Journal Article
SR Electronic
T1 Phenytoin Intoxication: Burden and risk factors
JF Neurosciences Journal
JO Neurosciences (Riyadh)
FD Prince Sultan Military Medical City
SP 166
OP 168
VO 6
IS 3
A1 Adnan A. Awada
A1 Saleh Al-Mezem
A1 Peter C. Amene
YR 2001
UL http://nsj.org.sa/content/6/3/166.abstract
AB OBJECTIVE: The aim of the study is to determine: 1) the frequency of patients admitted for phenytoin toxicity and their economic burden; 2) the clinical symptoms and signs of intoxication; 3) the causes or risk factors of intoxication, and 4) the ways to prevent phenytoin toxicity.METHODS: Retrospective review of hospital ICD coded database between 1987 and 1998. All patients with phenytoin intoxication were reviewed.RESULTS: Thirty-one patients were admitted 35 times for phenytoin toxicity. Phenytoin intoxication accounted for 1/5,000 admissions. Ataxia, confusion, dysarthria and nystagmus were the most common signs. The outcome was benign except for one patient who remained with a residual cerebellar syndrome. Unawareness of phenytoin pharmacokinetics, lack of clinic follow-up visits, infrequent serum level monitoring following drug dosage change and using wrong doses accounted for most of the cases.CONCLUSION: Phenytoin intoxication rarely leaves any permanent sequelae but can be a cause of significant transient morbidity and prolonged hospitalization. As the major causes were related to poor follow-up or were iatrogenic, a better patient education and a stepwise dose increase based on serum level, together with drug level monitoring 2-4 weeks after dose change could decrease the incidence and severity of phenytoin intoxication.