Toxicity, Phenytoin Follow-up

  • Author: Charlene A Miller, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Nov 4, 2010
 

Further Inpatient Care

Many patients with moderate toxicity require inpatient care because they are unable to ambulate from the severe ataxia or unable to eat secondary to the nausea. Adequate IV hydration should be maintained. These patients should be out of bed only with assistance because they are at high risk of falling and sustaining serious injuries.

Patients with the evidence of cardiac toxicity and ECG changes should be admitted to monitored settings

Numerous, repeat phenytoin levels are not required because symptoms and clinical signs allow determination of toxicity.

In chronic nonintentional overdoses, pay specific attention to the patient's pharmacopeia to determine if the toxicity was iatrogenic.

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Further Outpatient Care

For nonintentional overdoses, individuals with mild toxicity may be treated as outpatients if they are not so ataxic that risk of self-injury is a concern and if they are capable of maintaining adequate hydration despite their nausea. In these instances, carefully review their medications and correct any wrong dosages or drug interactions.

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Complications

The most common complications involve undiagnosed injuries sustained as a result of the phenytoin-induced ataxia.

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Patient Education

For excellent patient education resources, visit eMedicine's Drug Overdose Center and Poisoning - First Aid and Emergency Center. Also, see eMedicine's patient education articles Poisoning, Drug Overdose, Activated Charcoal, and Poison Proofing Your Home.

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Contributor Information and Disclosures
Author

Charlene A Miller, MD  Consulting Staff, Department of Emergency Medicine, Oakwood Hospital Medical Center

Charlene A Miller, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel M Joyce, MD  Consulting Staff, Department of Emergency Medicine, Saint Vincent's and Saint Mary's Medical

Daniel M Joyce, MD is a member of the following medical societies: American College of Emergency Physicians and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Lance W Kreplick, MD, MMM, FAAEM, FACEP  Medical Director of Hyperbaric Medicine, Fawcett Wound Management and Hyperbaric Medicine; Consulting Staff in Occupational Health and Rehabilitation, Company Care Occupational Health Services; President and Chief Executive Officer, QED Medical Solutions, LLC

Lance W Kreplick, MD, MMM, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP  Chair, Department of Emergency Medicine, Director of Medical Toxicology, Allegheny General Hospital; Associate Professor, Department of Emergency Medicine, Drexel University College of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

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