title: Changes in phenytoin concentrations in blood and cerebrospinal fluid caused by direct hemoperfusion in a patient intoxicated with phenytoin.
abstract: We performed direct hemoperfusion (DHP) 5 times on a patient with consciousness disorder and phenytoin intoxication. We then measured the phenytoin concentrations in her cerebrospinal fluid (CSF) and blood at various times. After the first DHP session, consciousness began to improve, and it normalized after the fourth DHP session when the blood concentration of phenytoin had decreased from 54.0 microg/ml to 16.5 microg/ml. The average plasma phenytoin elimination rate of DHP was 18.0% over 120-180 min. The concentration of phenytoin in the CSF decreased as that in the blood was lowered by DHP. The average reduction rate of phenytoin in the CSF after a DHP session was 23.7%, which was similar to the rate of elimination from the blood. The CSF/blood phenytoin ratio was 0.17, and no marked changes were detected before or after a DHP session.
authors.affiliation: Kidney Center, Department of Pharmacy, Saitama Medical Center, Saitama Medical School, Kawagoe, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kanayama
authors.forename: Y
authors.initials: Y
authors.lastname: Itakura
authors.forename: M
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Y
authors.initials: Y
authors.lastname: Hirahara
authors.forename: S
authors.initials: S
authors.lastname: Takasino
authors.forename: Y
authors.initials: Y
authors.lastname: Kawase
authors.forename: H
authors.initials: H
authors.lastname: Katoh
authors.forename: M
authors.initials: M
authors.lastname: Kinosita
authors.forename: O
authors.initials: O
authors.lastname: Matsumura
authors.forename: T
authors.initials: T
authors.lastname: Mitarai
authors.forename: K
authors.initials: K
authors.lastname: Isoda
mesh_terms: D000208:Acute Disease; D000927:Anticonvulsants / Q000506:poisoning*; D016903:Drug Monitoring; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D006464:Hemoperfusion / Q000379:methods; D006801:Humans; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D010672:Phenytoin / Q000506:poisoning*; D011041:Poisoning / Q000097:blood / Q000134:cerebrospinal fluid / Q000628:therapy / Q000652:urine; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin