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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Impaired Attention And Unsteadiness Of Gait While Treating Epilepsy

A woman with a history of epilepsy presents to the emergency room with impaired attention and unsteadiness of gait. Her phenytoin level is over the normal limit. Examination of the eyes would be most likely to show which of the following? ( ) A weakness of abduction of the left eye B lateral beating movements of the eyes C impaired convergence D papilledema E impaired upgaze
Wed, 2 Nov 2022
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Anesthesiologist,  's  Response
Hello,

Impaired attention and unsteadiness of gait seems to be phenytoin overdose symptoms. Phenytoin toxicity presents as neurotoxic effects are concentration dependent and can range from mild nystagmus to ataxia, slurred speech, vomiting, lethargy and eventually coma and death.

Paradoxically, at very high concentrations, phenytoin can lead to seizures. The following is a loose correlation of side effects with total plasma phenytoin concentrations:
Less than 10 mg/L: Rare side effects
Ten to 20 mg/L: Occasional mild horizontal nystagmus on lateral gaze
Twenty to 30 mg/L: Nystagmus
Thirty to 40 mg/L: Ataxia, slurred speech, tremor, nausea, and vomiting
Forty to 50 mg/L: Lethargy, confusion, hyperactivity
Greater than 50 mg/L: Coma and seizures
From the above, examination of her eyes most likely show lateral beating movements of the eyes which is nystagmus.

Take care. Hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Pallavi M., Anesthesiologist
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Suggest Treatment For Impaired Attention And Unsteadiness Of Gait While Treating Epilepsy

Hello, Impaired attention and unsteadiness of gait seems to be phenytoin overdose symptoms. Phenytoin toxicity presents as neurotoxic effects are concentration dependent and can range from mild nystagmus to ataxia, slurred speech, vomiting, lethargy and eventually coma and death. Paradoxically, at very high concentrations, phenytoin can lead to seizures. The following is a loose correlation of side effects with total plasma phenytoin concentrations: Less than 10 mg/L: Rare side effects Ten to 20 mg/L: Occasional mild horizontal nystagmus on lateral gaze Twenty to 30 mg/L: Nystagmus Thirty to 40 mg/L: Ataxia, slurred speech, tremor, nausea, and vomiting Forty to 50 mg/L: Lethargy, confusion, hyperactivity Greater than 50 mg/L: Coma and seizures From the above, examination of her eyes most likely show lateral beating movements of the eyes which is nystagmus. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Pallavi M., Anesthesiologist