Toxicity, Phenytoin Medication

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

Medication Summary

Treatment of phenytoin toxicity is primarily focused on limiting the systemic burden of phenytoin by GI decontamination and management of any seizures that may occur with benzodiazepines.

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GI decontaminant

Class Summary

Multiple dose activated charcoal is thought to enhance the elimination of phenytoin that was administered orally or intravenously.

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Activated charcoal (Liqui-Char)

 

Preferred GI decontamination method when decontamination is desired. It may be administered with a cathartic (eg, 70% sorbitol), except in young pediatric patients in whom electrolyte disturbances may be of concern. Limited benefit if administered greater than 1 h after ingestion.

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Benzodiazepines

Class Summary

Used for seizure control, although seizures in the presence of toxic levels of phenytoin are rare.

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Lorazepam (Ativan)

 

DOC for drug-induced seizures. Longer duration of action compared to the other agents.

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Midazolam (Versed)

 

IV/IM formulation with short duration of sedation. Used as alternative in termination of refractory status epilepticus. Because water soluble, takes approximately 3 times longer than diazepam to peak EEG effects. Thus, clinician must wait 2-3 min to fully evaluate sedative effects before initiating procedure or repeating dose.

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Diazepam (Valium)

 

Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA. Commonly available, also useful for treatment of seizures or agitation.

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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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