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Journal of Case Reports
Encephalopathy due to Phenytoin Toxicity Presenting with a Striking Diurnal Fluctuation in an Elderly Man
Parul Dubey1, Carmen Perreira2, Varun Pai Kakode3, Bhawna Sharma4, Raghavendra Sannegowda5
1Department of Neurology, Manipal Hospital, Goa; Department of 2Medicine and 3Neurology, Goa Medical College, Bambolim Goa; 4Department of Neurology, SMS Medical College, Jaipur, Rajasthan; 5Department of Neurology, Father Muller Medical College and Hospital, Mangalore, Karnataka, India.
Corresponding Author:
Dr. Parul Dubey
Email: drdubeyparul@gmail.com
Received: 18-DEC-2018 Accepted: 02-MAY-2019 Published Online: 05-MAY-2019
DOI: http://dx.doi.org/10.17659/01.2019.0024
Abstract
Background: Undiagnosed phenytoin toxicity in elderly may pose dangers of falls and debility which could be otherwise totally averted. Clinicians need to be aware that though easily available, phenytoin is one of the difficult drugs to dose appropriately owing to its saturable metabolism and a narrow therapeutic window. The difficulty is compounded in the elderly, due to compromised  metabolism  and erratic clearance of the drug. Case Report: We present a case of an elderly man with fluctuating encephalopathy with a striking diurnal variation, ranging from stupor to a conscious and alert state during the course of the day, which turned out to be due to phenytoin toxicity. Conclusion: Phenytoin should be used with caution in the elderly.
Keywords : Anticonvulsants, Brain Diseases, Consciousness, Phenytoin, Stupor.
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Androxal Medication Case Reports Journal

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