Acute diphenylhydantoin and primidone poisoning treated by peritoneal dialysis.

Extracorporeal Treatment in Phenytoin Poisoning: Systematic Review and Recommendations from the EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup

“…70,81 Although the natural history of severely poisoned patients not treated with ECTR suggests survival, 111,112 irreversible neurological conditions may incur in those most at risk. [23][24][25] In our cohort, survival was noted in some patients who reportedly ingested 10 grams or greater, 33,67,69,71,84 and who had peak total phenytoin concentrations over 90 mcg/mL. 33,35,66,70,75,87,88 Complications associated with ECTR included thrombocytopenia after hemoperfusion, 18,88 and peritonitis following peritoneal dialysis that led to death.…”

“…37 Further studies are needed to confirm the role of liver support therapies, especially considering their cost. Other ECTRs show limited phenytoin clearance (< 10 mL/min) 113 including exchange transfusion (ET), 76 peritoneal dialysis (PD), 68,69 and continuous renal replacement therapy (CRRT) 100,104 and are therefore of very limited use in phenytoin poisoning.…”

Organic convergence spasm

“…Convergence spasm has, as far as we are aware, not been described in diphenylhydantoin intoxication (Orth et al 1967, Blair et al 1968, Spector et al 1976) although choreiform movements and dystonia have been reported (Chadwick et al 1976, Chalhub et al 1976). Its association with transient loss of awareness in our patient is puzzling.…”