Phenytoin overdose

Home treatment:

The standard procedure is to induce emesis (vomiting) unless the patient is unconscious or experiencing convulsions. Before inducing emesis, contact Poison Control for verification.

If instructed to induce emesis, the standard procedure is as follows:

Give the usual dose of ipecac syrup: 15 milliliters (ml) or 1 TABLEspoonful for children and 30 ml (2 TABLEspoonsful) for adults. Follow with 1/2 glassful or 4 ounces (oz.) of water for children or 8 to 12 oz. of water for adults. Repeat 1 more time in 1/2 hour if emesis has not occurred.

Before calling emergency:

Determine the following information:

• the patient's age, weight, and condition
• name of product (as well as the ingredients and strength if known)
• the time it was swallowed
• the amount swallowed
• if the medication was prescribed for the patient

Poison Control, or a local emergency number:

They will instruct you if it is necessary to take the patient to the hospital. See Poison Control centers for telephone numbers and addresses. Take the container with you to the emergency room.

What to expect at the emergency room:

Some or all of the following procedures may be performed:

• Maintain the airway.
• Maintain breathing.
• Induce emesis if the patient is conscious.
• Administer activated charcoal.
• Administer a laxative.
• Use gastric lavage.
• Observe the patient closely.
• Monitor phenytoin blood levels.
• Treat the symptoms.

Expectations (prognosis):

Mild overdose:

• The patient can be aroused.
• No treatment is necessary.

Moderate overdose:

• The patient cannot be aroused, but vital functions are normal.
• Recovery is usually within 24 to 48 hours with proper treatment.

Severe overdose:

• The patient cannot be aroused and vital signs (temperature, pulse, rate of breathing, blood pressure) are abnormal.
• Even with proper treatment, a 3 to 5 day period may be required before the patient recovers. The fatality rate is less than 5%.