Changes in phenytoin concentrations in blood and cerebrospinal fluid caused by direct hemoperfusion in a patient intoxicated with phenytoin

We performed direct hemoperfusion (DHP) 5 times on a patient with consciousness disorder and phenytoin intoxication. We then measured the phenytoin concentrations in her cerebrospinal fluid (CSF) and blood at various times. After the first DHP session, consciousness began to improve, and it normaliz...

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Bibliographic Details
Published inTherapeutic apheresis Vol. 2; no. 1; p. 74
Main Authors Kanayama, Y, Itakura, Y, Iwasaki, M, Hirahara, Y, Takasino, S, Kawase, Y, Katoh, H, Kinosita, M, Matsumura, O, Mitarai, T, Isoda, K
Format Journal Article
LanguageEnglish
Published United States 01.02.1998
Subjects
Acute Disease
Anticonvulsants - poisoning
Drug Monitoring
Epilepsy - drug therapy
Female
Hemoperfusion - methods
Humans
Metabolic Clearance Rate
Middle Aged
Phenytoin - poisoning
Poisoning - blood
Poisoning - cerebrospinal fluid
Poisoning - therapy
Poisoning - urine
Time Factors
Treatment Outcome
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Summary:We performed direct hemoperfusion (DHP) 5 times on a patient with consciousness disorder and phenytoin intoxication. We then measured the phenytoin concentrations in her cerebrospinal fluid (CSF) and blood at various times. After the first DHP session, consciousness began to improve, and it normalized after the fourth DHP session when the blood concentration of phenytoin had decreased from 54.0 microg/ml to 16.5 microg/ml. The average plasma phenytoin elimination rate of DHP was 18.0% over 120-180 min. The concentration of phenytoin in the CSF decreased as that in the blood was lowered by DHP. The average reduction rate of phenytoin in the CSF after a DHP session was 23.7%, which was similar to the rate of elimination from the blood. The CSF/blood phenytoin ratio was 0.17, and no marked changes were detected before or after a DHP session.
ISSN:1091-6660
DOI:10.1111/j.1744-9987.1998.tb00077.x