We evaluated the efficacy of constant intravenous (IV) phenytoin infusion. Oral loading may be associated with a slightly higher incidence of nausea and vomiting, and although it achieved therapeutic levels within a few hours, its peak effect is not apparent until 8-12 hours following administration. Wiley There is limited data regarding an adjustment factor for loading phenytoin in obese patients. Unable to load your collection due to an error IV … This site needs JavaScript to work properly.

Swadron SP(1), Rudis MI, Azimian K, Beringer P, Fort D, Orlinsky M. Author information: (1)Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Clipboard, Search History, and several other advanced features are temporarily unavailable. Certain patient populations, such as the obese, have been shown to present dosing challenges. Phenytoin is a common anticonvulsant used for the acute treatment of seizures in the emergency department (ED). The most commonly cited trial

A single 18 mg/kg dose of oral phenytoin capsules or suspension (mean dose, 1.3 g) was given to 44 patients with recent seizures and … Following the use of diazepam in patients having continuous seizures and in the initial management of serial epilepsy a loading dose of phenytoin 10 - 15mg/kg should be injected slowly intravenously, at a rate not exceeding 50mg per minute in adults (this will require approximately 20 minutes in a 70kg patient).

He describes a history of seizure disorder and is prescribed phenytoin, but recently ran out. Emergency Medicine Cases (EM Cases) is a free online medical education podcast, medical blog and website dedicated to providing online emergency medicine education and CME for physicians, residents, students nurses and paramedics. Based on the patient's current dose and the measured concentration (columns 1 and 2), column 3 gives a rough guide to interpretation of the result and possible dosage adjustment. Phenytoin is a medicine used to treat epilepsy.

Please enable it to take advantage of the complete set of features! An IV was not placed.Drug references say that an oral loading dose (15-20 mg/kg) of phenytoin should be administered in 3 divided doses given every 2 hours to decrease GI adverse effects and to ensure complete oral absorption. 2017 Feb;7(1):45-52. doi: 10.1212/CPJ.0000000000000322.Nakamura K, Inokuchi R, Daidoji H, Naraba H, Sonoo T, Hashimoto H, Tokunaga K, Hiruma T, Doi K, Morimura N.Medicine (Baltimore). Two studies have examined the safety and efficacy of phenytoin oral loading doses. For a 1 gm dose, that would be 400 mg, then 300 mg, then 300 mg administered every 2 hours (4 hour total administration time).Who has time for three doses spanned over 4+ hours in a busy ED?If you’re still uncomfortable giving a large single dose, there is also support for two-dose oral loading (which still cuts 2 hours off the ED stay compared to 3 doses).ALiEM is your digital connection to the cooperative world of EM. All rights reserved. Fosphenytoin (Cerebyx) is a more water-soluble prodrug form of phenytoin that allows for faster IV infusion and less risk of extravasation injury.

$$ This calculator uses the average of the following correction equations. Diluting phenytoin is safe but there is limited evidence regarding adverse effects of diluted phenytoin; a filter … 1998 Oct;13 Suppl 1:S15-8; discussion S30-2. Name must be less than 100 characters doi: 10.1111/j.1553-2712.2004.tb02204.x.