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Phenytoin Poisoning

Phenytoin Poisoning is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Phenytoin follows zero-order pharmacokinetics:
    • Small incremental increase in dose can result in a large increase in plasma concentration.
  • Half-life in overdose prolonged; may be up to 70 hr
  • Cardiovascular toxicity from IV administration likely due to the diluent propylene glycol
  • Fosphenytoin, a prodrug for parenteral administration, is metabolized to phenytoin, its active moiety.

Etiology

  • Phenytoin intoxication results from acute, chronic, or acute-on-chronic administration.
  • If the cause of the intoxication is unclear in a patient receiving chronic phenytoin therapy, consider that there may have been a:
    • Change in the brand of phenytoin
    • Change in dosage form
    • Drug interaction
    • Change in serum albumin

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Citation

Rosen, Peter, et al., editors. "Phenytoin Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307058/all/Phenytoin_Poisoning.
Phenytoin Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307058/all/Phenytoin_Poisoning. Accessed April 24, 2019.
Phenytoin Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307058/all/Phenytoin_Poisoning
Phenytoin Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307058/all/Phenytoin_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Phenytoin Poisoning ID - 307058 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307058/all/Phenytoin_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -