title: Noncompliance leading to drug accumulation resulting in phenytoin toxicity.
abstract: Phenytoin is effective in suppressing tonic-clonic and partial seizures, and is widely used for initial therapy, particularly in adults. Ninety percent of phenytoin is protein bound and entirely eliminated by hepatic metabolism. The major metabolite of phenytoin, 5-(p-hydroxyphenyl)-5phenylhy-dantoin (5HPPH) is excreted in the urine. Higher phenytoin levels for a given dose of phenytoin can be seen in alcohol intoxication, hepatic and renal failures, hypoalbuminemia, nephrotic syndrome, trauma, and AIDS. Noncompliance can lead to accumulation of the drug-causing toxicity. We present a patient with acute alcohol intoxication who developed phenytoin toxicity due to noncompliance with the drug.
authors.affiliation: Center for Sickle Cell Disease, 2121 Georgia Avenue NW, Washington, DC 20059, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Akula
authors.forename: Syed
authors.initials: S
authors.lastname: Hasan
authors.forename: Rao
authors.initials: R
authors.lastname: Pipalla
authors.forename: Clifford
authors.initials: C
authors.lastname: Ferguson
mesh_terms: D000435:Alcoholic Intoxication; D000927:Anticonvulsants / Q000493:pharmacokinetics / Q000506:poisoning*; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D010349:Patient Compliance; D010672:Phenytoin / Q000493:pharmacokinetics / Q000506:poisoning*
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin