Phenytoin overdose treated with hemodialysis using a high cut-off dialyzer.
We describe the case of a 52-year-old man who presented after having ingested an unknown quantity of phenytoin. Peak phenytoin concentration was 51.2 mg/L (therapeutic range 10-20 mg/L). Five days after admission, the patient became comatose and was intubated. Because of persistent toxic phenytoin levels and unchanged clinical status for 12 days, hemodialysis (HD) was prescribed to enhance elimination of phenytoin. HD was performed using a Gambro TheraliteTMfilter (Baxter International Inc., Deerfield, USA), a high cut-off filter that allows the removal of molecules of up to 45 kDa. Phenytoin concentration readily decreased during the 8-hour HD treatment from 38.9 mg/L to 27.8 mg/L (28.5% decrease); during HD, phenytoin half-life was 18.5h (compared to 1109.8h before HD and 56.3h after HD), phentyoin clearance averaged 80.1 mL/min and a total of 1.1 g of phenytoin was removed. Albumin removal from the Theralite filter was most important at the beginning of HD. The high clearance of phenytoin obtained with this filter was likely due to its high surface area rather than its capacity to remove the albumin-phenytoin complex.
Verdun Hospital, Université de Montréal, Montréal, Quebec, Canada.
Monique J
MJ
Cormier
Centre Hospitalier Universitaire de Québec, Quebec, Canada.
Simon
S
Desmeules
Centre Hospitalier Universitaire de Québec, Quebec, Canada.
Maude
M
St-Onge
Verdun Hospital, Université de Montréal, Montréal, Quebec, Canada.
Marc
M
Ghannoum
D000927:Anticonvulsants / Q000633:toxicity*; D062787:Drug Overdose / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000633:toxicity*; D006435:Renal Dialysis / Q000379:methods*
D000927:Anticonvulsants; D010672:Phenytoin
Phenytoin; albumin; hemodialysis; intoxication