title: Treatment of severe intravenous phenytoin overdose with hemodialysis and hemoperfusion.
abstract: BACKGROUND
  Phenytoin is a widely used anticonvulsant agent responsible for a number of intentional and unintentional overdoses. However, besides supportive care, specific treatment recommendations to enhance elimination of the parent compound have been discussed controversially and effectiveness of hemoperfusion is under debate.
  
  
  METHODS
  A women with a prehistory of cerebral seizures was presented following a severe iatrogenic phenytoin overdose with a peak plasma concentration of 117 mg/L. A Phenytoin overdose could be contributed to both inadequate dosing and missed repeated drug monitoring. Native phenytoin body clearance failed to relevantly lower phenytoin concentration. Thus, three sessions of a four-hour long combination of activated charcoal hemoperfusion and high-flux hemodialysis were performed resulting in considerably reduced half-life during these measures of about 7-13 hours compared to the native half-life wavering between 40-100 hours. This resulted in a substantial clinical improvement in terms of central nervous system toxicity.
  
  
  CONCLUSIONS
  Hemodiaperfusion with activated charcoal seems to be a reasonable measure for forced lowering of highly toxic phenytoin plasma concentration and should be considered especially in circumstances following intravenous overdose (e.g. inadequate iatrogenic dosing). Its narrow therapeutic range enforces strictly adequate dosing and subsequent repeated drug monitoring of phenytoin.
authors.affiliation: Department of Toxicology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany. florian.eyer@t-online.de
authors.forename: Florian
authors.initials: F
authors.lastname: Eyer
authors.forename: Norbert
authors.initials: N
authors.lastname: Felgenhauer
authors.forename: Rudi
authors.initials: R
authors.lastname: Pfab
authors.forename: Klaus
authors.initials: K
authors.lastname: Thürmel
authors.forename: Thomas
authors.initials: T
authors.lastname: Zilker
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*; D062787:Drug Overdose / Q000628:therapy*; D005260:Female; D006464:Hemoperfusion; D006801:Humans; D010672:Phenytoin / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*; D006435:Renal Dialysis; D012640:Seizures / Q000188:drug therapy
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin