Miscellaneous Effects

Other side effects from phenytoin include gingival hyperplasia, hirsutism, hypocalcemia, megaloblastic anemia responsive to folate administration, lymphoma, and hemorrhagic disease of the newborn responsive to vitamin K (T.a.ble.,..1Z2.-.4). Gingival hyperplasia is so common, its absence should suggest poor compliance. Another clinically significant effect in some is hyperglycemia, felt to be secondary to inhibition of insulin release. This can lead to diabetic ketoacidosis or nonketotic hyperosmolar coma in diabetics. The teratogenic fetal hydantoin syndrome is well described, so oral phenytoin therapy in a pregnant patient should never be initiated or continued by an emergency physician without consultation and close follow-up from an attending neurologist and obstetrician.

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