Phenytoin
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Various toxicities including neurological manifestations in children: 2 case reports Two boys, who had sustained head injuries, developed various toxicities including neurological manifestations during treatment with phenytoin. A 2-year-old boy presented with vomiting, lethargy, loss of speech, fever and numerous episodes of generalised tonic clonic seizures (GTCS) of 5 days’ duration. He was also experiencing difficulty in walking and then also in sitting. He had sustained a head injury with a fracture of the occipital bone 15 days prior to presentation. A neurological examination showed terminal neck stiffness, alterations in sensory input, reduced motor strength, nystagmus, a bilateral extensor plantar response and lower limb hyperreflexia. The provisional diagnosis was meningoencephalitis. However, investigations revealed that during the previous 15 days he had received a number of loading doses of phenytoin [route and dosage not stated] at different facilities. A serum phenytoin concentration was then obtained and showed a concentration of 62.9 µg/mL. Phenytoin was discontinued and 1 week later he showed improvements in sensory input, abatement of his fever and control of seizures. A repeat serum phenytoin concentration was 22.6 µg/mL. A 3-year-old boy, weighing 10kg, presented with vomiting and fever. He also had a 2-day history of two episodes of GTCS and a 1-day history of inability to stand and walk. He had sustained a head injury with a frontal bone fracture and extra dural haemorrhage 13 days prior to presentation. A neurological examination showed alterations in sensory input, urinary retention, nystagmus, reduced motor strength, ataxia with a bilateral flexor plantar response. The provisional diagnosis was meningoencephalitis. Investigations revealed that for the past 15 days [sic] he had been receiving phenytoin syrup [Dilantin] 375 mg/day administered in 3 doses daily. Laboratory testing showed a phenytoin concentration of 62.5 µg/mL. Phenytoin was discontinued and from day 5 postadmission, he exhibited signs of improvement . On day 9, his symptoms had resolved. Author comment: "Chronic phenytoin toxicity may mimic various neurological disorders like cerebellar and brainstem lesions, or subarachnoid hemorrhage." Gupta V, et al. Phenytoin toxicity presenting as acute meningo-encephalitis in children. Neurology India 59: 66-67, No. 1, Feb 2011. Available from: URL: http:/ 803052849 /dx.doi.org/10.4103/0028-3886.76862 - India
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Reactions 16 Apr 2011 No. 1347
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