title: Phenytoin intoxication with no symptoms correlated with serum drug level: a case study.
abstract: In high-dose intake of phenytoin, which is used frequently to treat epilepsy, nystagmus, diplopia, nausea-vomiting, lethargy, confusion, seizure, and coma can be observed. In recent studies on phenytoin intoxication, in which seizure and coma were observed in drug levels greater than 50 ug/mL. The serum phenytoin level of a patient, who consumed approximately 100 pcs of 100 mg phenytoin tablets in an effort to commit suicide, and who had no pathological finding in her neurologic examination, was 124 ug/mL. High drug level and the absence of toxic effect (or the absence of toxic effect correlated with the drug level) indicates that cytochrome P450 is functioning, but there can be a mutation in the MDR1 gene. In our case study, we report on phenytoin intoxication in a patient having a high level of phenytoin but no symptoms correlated with serum drug level, as supported by the findings in the literature.
authors.affiliation: Adnan Menderes University, Department of Emergency Medicine, Aydin, Turkey.
authors.forename: Mucahit
authors.initials: M
authors.lastname: Avcil
authors.affiliation: Adnan Menderes University, Department of Emergency Medicine, Aydin, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Duman
authors.affiliation: Adnan Menderes University, Department of Emergency Medicine, Aydin, Turkey.
authors.forename: Kenan Ahmet
authors.initials: KA
authors.lastname: Turkdogan
authors.affiliation: Adnan Menderes University, Department of Emergency Medicine, Aydin, Turkey.
authors.forename: Mucahit
authors.initials: M
authors.lastname: Kapci
authors.affiliation: Adnan Menderes University, Department of Emergency Medicine, Aydin, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Akoz
authors.affiliation: Adnan Menderes University, Department of Emergency Medicine, Aydin, Turkey.
authors.forename: Selcuk Eren
authors.initials: SE
authors.lastname: Canakci
authors.affiliation: Adnan Menderes University, Department of Emergency Medicine, Aydin, Turkey.
authors.forename: Yunus Emre
authors.initials: YE
authors.lastname: Ozluer
mesh_terms: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000235:genetics; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D009154:Mutation; D010672:Phenytoin / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000506:poisoning*; D013406:Suicide, Attempted
chemical_list: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D000927:Anticonvulsants; D010672:Phenytoin
keywords: Phenytoin intoxication; emergency service; serum level