Version May 2024
| To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222 for the nearest regional poison control center. Contact information for poison control centers around the world is available at the WHO website and in the UpToDate topic on regional poison control centers (society guideline links). |
| General |
| Phenytoin is an anticonvulsant; fosphenytoin is a prodrug of phenytoin |
| Neurological signs are by far the most common manifestation of phenytoin overdose |
| Rapid IV administration can cause hypotension, bradyarrhythmia, and possibly asystole |
| Clinical features |
| Mild poisoning: horizontal nystagmus, unsteady gait, worsening coordination |
| Severe poisoning: slurred speech; depressed mental status (possibly coma) |
| Laboratory/diagnostic evaluation |
| Phenytoin toxicity |
| Obtain phenytoin serum concentration |
| Obtain serum albumin if phenytoin concentration and clinical findings inconsistent; hypoalbuminemia predisposes to toxicity |
| Routine testing in poisoned patients |
| Fingerstick glucose if mental status altered |
| Acetaminophen and salicylate concentrations if possible suicide attempt |
| ECG to assess for poisoning by drugs that effect QRS or QTc intervals |
| Pregnancy test in women of childbearing years |
| Treatment |
| Administer activated charcoal (1 g/kg up to 50 g) for symptomatic acute ingestions, unless airway is not protected or other contraindications exist |
| Administer activated charcoal (1 g/kg up to 50 g) for asymptomatic patients who report significant ingestions if less than 1 to 2 hours after ingestion |
| Provide supportive care as needed |
| Disposition |
| Patients with acute toxicity or moderate to severe symptoms from chronic toxicity should be hospitalized |
| Children may manifest signs of phenytoin toxicity at lower serum concentrations than adults and thus are more likely to require admission |
| Patients with chronic toxicity may be discharged if they can ambulate safely and have someone to monitor them and assist with their activities of daily living until toxicity has resolved |
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