Plasmapheresis as an Adjunctive Therapy in Phenytoin Poisoning
Phenytoin is frequently used as an anticonvulsant. Phenytoin has saturable metabolic kinetics in overdose circumstances, making therapy challenging. Because of its high protein binding property, the usual hemodialysis and hemoperfusion are not usually preferred. We report a case of a chronic overdos...
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Wolters Kluwer Medknow Publications
2024-11-01
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| Series: | Global Journal of Transfusion Medicine |
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| Online Access: | https://journals.lww.com/10.4103/gjtm.gjtm_44_24 |
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| author | Purshotam Paudel Dibyajyoti Sahoo Abhishekh Basavarajegowda Raushan Afroz |
| author_facet | Purshotam Paudel Dibyajyoti Sahoo Abhishekh Basavarajegowda Raushan Afroz |
| author_sort | Purshotam Paudel |
| collection | DOAJ |
| description | Phenytoin is frequently used as an anticonvulsant. Phenytoin has saturable metabolic kinetics in overdose circumstances, making therapy challenging. Because of its high protein binding property, the usual hemodialysis and hemoperfusion are not usually preferred. We report a case of a chronic overdose in which an attempt was made to decrease the toxicity and lower plasma levels of phenytoin using plasmapheresis. A 60-year-old female with a history of seizure disorder on phenytoin for the last 25 years and asthma for 15 years on salbutamol when needed presented with a sudden onset of vomiting followed by altered sensorium in the form of drowsiness and decreased responsiveness. She was suspected of having phenytoin toxicity and given a stomach elsewhere. Her phenytoin level after admission to our center was 46 mg/mL (therapeutic range: 10–20 mg/mL). The initial assessment of the patient was done by the treating physician. As the patient did not improve with supportive management, the transfusion medicine department received the request to conduct a therapeutic plasmapheresis. The first session of plasmapheresis was performed using the Haemonetics MCS machine. After the procedure, her phenytoin level decreased by 43% from the baseline, and she was shifted out of the intensive care unit to the ward and discharged after 2 weeks. |
| format | Article |
| id | doaj-art-e57297c4daa2499e800c8c96a42f3d9c |
| institution | OA Journals |
| issn | 2468-8398 2455-8893 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Global Journal of Transfusion Medicine |
| spelling | doaj-art-e57297c4daa2499e800c8c96a42f3d9c2025-08-20T02:19:34ZengWolters Kluwer Medknow PublicationsGlobal Journal of Transfusion Medicine2468-83982455-88932024-11-019215816010.4103/gjtm.gjtm_44_24Plasmapheresis as an Adjunctive Therapy in Phenytoin PoisoningPurshotam PaudelDibyajyoti SahooAbhishekh BasavarajegowdaRaushan AfrozPhenytoin is frequently used as an anticonvulsant. Phenytoin has saturable metabolic kinetics in overdose circumstances, making therapy challenging. Because of its high protein binding property, the usual hemodialysis and hemoperfusion are not usually preferred. We report a case of a chronic overdose in which an attempt was made to decrease the toxicity and lower plasma levels of phenytoin using plasmapheresis. A 60-year-old female with a history of seizure disorder on phenytoin for the last 25 years and asthma for 15 years on salbutamol when needed presented with a sudden onset of vomiting followed by altered sensorium in the form of drowsiness and decreased responsiveness. She was suspected of having phenytoin toxicity and given a stomach elsewhere. Her phenytoin level after admission to our center was 46 mg/mL (therapeutic range: 10–20 mg/mL). The initial assessment of the patient was done by the treating physician. As the patient did not improve with supportive management, the transfusion medicine department received the request to conduct a therapeutic plasmapheresis. The first session of plasmapheresis was performed using the Haemonetics MCS machine. After the procedure, her phenytoin level decreased by 43% from the baseline, and she was shifted out of the intensive care unit to the ward and discharged after 2 weeks.https://journals.lww.com/10.4103/gjtm.gjtm_44_24phenytoinplasma exchangetoxicity |
| spellingShingle | Purshotam Paudel Dibyajyoti Sahoo Abhishekh Basavarajegowda Raushan Afroz Plasmapheresis as an Adjunctive Therapy in Phenytoin Poisoning Global Journal of Transfusion Medicine phenytoin plasma exchange toxicity |
| title | Plasmapheresis as an Adjunctive Therapy in Phenytoin Poisoning |
| title_full | Plasmapheresis as an Adjunctive Therapy in Phenytoin Poisoning |
| title_fullStr | Plasmapheresis as an Adjunctive Therapy in Phenytoin Poisoning |
| title_full_unstemmed | Plasmapheresis as an Adjunctive Therapy in Phenytoin Poisoning |
| title_short | Plasmapheresis as an Adjunctive Therapy in Phenytoin Poisoning |
| title_sort | plasmapheresis as an adjunctive therapy in phenytoin poisoning |
| topic | phenytoin plasma exchange toxicity |
| url | https://journals.lww.com/10.4103/gjtm.gjtm_44_24 |
| work_keys_str_mv | AT purshotampaudel plasmapheresisasanadjunctivetherapyinphenytoinpoisoning AT dibyajyotisahoo plasmapheresisasanadjunctivetherapyinphenytoinpoisoning AT abhishekhbasavarajegowda plasmapheresisasanadjunctivetherapyinphenytoinpoisoning AT raushanafroz plasmapheresisasanadjunctivetherapyinphenytoinpoisoning |