Phenytoin adverse effects

What it is

Phenytoin is a second line drug for status epilepticus, which is continuous seizure activity for more than 5-10 min, or 2 or more seizures without full recovery. First line is a benzodiazepine, lorazepam or diazepam or midazolam, and if the first dose does not work a second dose of the first line is given before moving on. If seizures continue, second line is phenytoin 20 mg/kg or fosphenytoin 20 mg/kg, with valproate, levetiracetam and lacosamide as the other drugs of this step, and phenobarbital 20 mg/kg either here or as the step just after it. If seizures still continue, third line is general anesthesia with propofol, midazolam, pentobarbital or ketamine. The rate matters as much as the dose: phenytoin has a max infusion of 50 mg/min, while fosphenytoin has a higher max, 150 mg/min, also written 150 PE/min for a dose written as 20 PE/kg. The bloods sent in the first minutes of status epilepticus include AED levels, along with CMP, CBC, ABG, alcohol and a toxicology screen.