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Dilantin Toxicity
Aka: Dilantin Toxicity, Phenytoin Toxicity
- See Also
- Phenytoin
- Fetal Hydantoin Syndrome
- Signs
- Phenytoin level 20 to 30 mcg/ml
- Nystagmus on lateral gaze
- Smooth Extraocular Movements lost
- Sedation
- Phenytoin level >30 mcg/ml
- Vertical Nystagmus
- Diplopia
- Ataxia or lurching gait
- Coarse extremity Tremor
- Slurred speech
- Altered Level of Consciousness
- Phenytoin Level >95 mcg/ml
- Lethal (deaths have occurred as low as 50 mcg/ml)
- Differential Diagnosis
- Posterior fossa tumor
- Acute viral cerebellitis
- Guillain-Barre Syndrome
- Botulism
- Anxiety Disorder
- Labs: Serial levels
- Serum free Phenytoin
- Serum Glucose
- Serum Creatinine
- Urinalysis
- Electrocardiogram
- Liver Function Tests
- Management
- Manage Hypotension
- Gastric Decontamination
- Treat complete Heart Block
- Atropine
- Pacemaker
- Treat Seizures
- Diazepam 0.1 to 0.3 mg/kg IV to 20 mg/dose
- May repeat Diazepam dosing in 20 minutes
- References
- Ellenhorn (1997) Medical Toxicology, p. 605-8
- Katzung (1989) Pharmacology, p. 289-91