Neurology Book

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Dilantin Toxicity

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

PHENYTOIN TOXICITY (C0149969)

Concepts Injury or Poisoning (T037)
English PHENYTOIN TOXICITY
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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