Phenytoin
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Intertrochanteric femur fracture and osteomalacia secondary to hypocalcaemia: case report An 82-year-old woman developed intertrochanteric femur fracture and osteomalacia secondary to hypocalcaemia during treatment with phenytoin for epileptic seizure. The woman, who had a history of epilepsy, was admitted with bilateral intertrochanteric femur fractures. Her seizures consisted of daily early morning myoclonus and occasional generalised tonic-clonic seizures. Anamnesis revealed that, she had been receiving treatment with phenytoin 100mg twice daily [route not stated]. Physical examination showed both legs were in external rotation, and she was unable to move her legs due to pain. Laboratory investigation showed decreased serum calcium level, increased intact parathormone level, increased homocysteine level and serum phenytoin level of 0.9 µg/mL. Following physical examination, the physician evaluated her pelvis anterior-posterior (AP) roentgenogram, which resulted in the diagnosis of bilateral intertrochanteric femur and osteomalacia secondary to hypocalcaemia. On the 14th day of the trauma, the woman was operated bilaterally under general anaesthesia in one session first for the right hip and then for left hip. After the operation, she was monitored in the ICU for the first 24 hours. On the second day of operation, she was mobilised and was able to walk with crutches. For hypocalcaemia a medical treatment was arranged following consultation. On the fifth day after the operation, she was discharged from the hospital [not all outcomes stated]. Author comment: "Antiepileptic medications may affect intestinal calcium absorption". "When used for long periods, anticonvulsant drugs cause osteomalacia." "Several factors may contribute to the increased fracture risk in seizure patients." Copuroglu C, et al. Late-diagnosed bilateral intertrochanteric femur fracture during an epileptic seizure. Ulusal Travma ve Acil Cerrahi Dergisi = Turkish Journal of Trauma and Emergency Surgery: TJTES 18: 92-94, No. 1, 2012. Available from: 803442993 URL: http://doi.org/10.5505/tjtes.2012.76402 - Turkey
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Reactions 4 Jan 2020 No. 1785
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