Admission Considerations

Patients with serious complications following an oral ingestion (seizures, coma, altered mental status, ataxia, etc.) should be admitted for further evaluation and treatment. Others with only mild symptoms may be treated with activated charcoal in the emergency department and discharged after their levels have returned to normal, provided they are not actively suicidal. Prolonged observation and frequent assessment of levels is not practical in many emergency departments. Thus, patients with continuing symptoms may need to be admitted or their case followed in an observation unit. Given the long and erratic absorption phase of phenytoin after oral overdose, the decision to discharge or medically clear a patient for psychiatric evaluation cannot be based on a single serum level. Patients with symptomatic chronic intoxication should be admitted for observation unless signs are minimal, adequate care can be obtained at home, and they are 8 to 12 h from their last therapeutic dose. Phenytoin therapy should be stopped in all cases and, if toxicity continues to resolve, a serum level may be reassessed in 2 to 3 days to guide resumption of therapy.

Patients with significant or persistent complications following the intravenous administration of phenytoin should be admitted. Those with transient effects need not be. CHAPTER REFERENCES

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