Phenytoin overdose complicated by prolonged intoxication and residual neurological deficits.
This report describes a case of massive phenytoin deliberate self-poisoning, notable for delayed peak serum concentrations, multiple general complications, and permanent cerebellar injury. A 38-year-old 70 kg male patient presented to the ED after ingestion of at least 10 g of phenytoin 12-16 h earlier. Marked cerebellar dysfunction and persistent vomiting were observed, with an initial serum phenytoin concentration of 181 micromol/L. Initial conservative treatment (activated charcoal, whole bowel irrigation), and later attempts at charcoal haemoperfusion were unsuccessful. The serum phenytoin concentration peaked on day 15 (354 micromol/L). The patient developed seizures followed by a prolonged depression in conscious state requiring intubation. Multiple medical sequelae occurred and the patient was discharged to a rehabilitation facility 100 days after admission exhibiting signs consistent with permanent cerebellar dysfunction.
Monash Medical Centre, Melbourne, Victoria, Australia. simoncraig@email.com
Simon
S
Craig
D000328:Adult; D002526:Cerebellar Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D002606:Charcoal / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods; D062787:Drug Overdose; D004635:Emergency Medicine / Q000379:methods*; D006464:Hemoperfusion; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D010672:Phenytoin / Q000097:blood / Q000506:poisoning*; D016728:Self-Injurious Behavior / Q000628:therapy*; D016896:Treatment Outcome
D002606:Charcoal; D010672:Phenytoin