Phenytoin toxicity in children – A tertiary center experience

Phenytoin is a widely used anti-seizure medication that has a narrow therapeutic index, and the peak plasma concentration is reached in 4–8 h. This study is a retrospective case series of 15 children presenting with phenytoin toxicity to a tertiary care pediatric hospital over 18 months. Descriptive statistics were used. In our study, of the 15 children included, 60% were male and 40% were female. The mean age was 7.5 ± 5.3 years. The clinical presentations were cerebellar ataxia (15/15), gaze-evoked nystagmus (14/15), intentional tremor (14/15), acute encephalopathy (12/15), behavioral abnormalities (11/15), seizures (5/15), dystonia (4/15), and deep encephalopathy requiring mechanical ventilation (2/15). On reviewing the available documents, 3/15 of the children had improper methods of administration. The mean time of resolution of toxicity symptoms was 8.3 ± 3.9 days. The clinical presentation can mimic an array of neurological symptoms and can sometimes mislead clinicians toward unnecessary investigations and treatment strategies.