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Interaction of Oral Phenytoin with Enteral Feedings
Author(s) -
Saklad Judith J.,
Graves Richard H.,
Sharp William P.
Publication year - 1986
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607186010003322
Subject(s) - phenytoin , medicine , enteral administration , anesthesia , status epilepticus , bolus (digestion) , parenteral nutrition , epilepsy , surgery , psychiatry
A 48‐yr‐old man with squamous cell carcinoma of the lung, hypercalcemia, and brain metastases with seizures was treated with phenytoin. Constant nasogastric infusion with Osmolyte was begun for hydration and nutritional status, necessitating an increase in his phenytoin dosage. Adequate seizure control and phenytoin levels were obtained on this adjusted regimen. However, on the 16th hospital day, the patient pulled out his nasogastric tube and received two doses of phenytoin without Osmolyte. The patient became lethargic, and his phenytoin level was 53 μg/ml. The patient was placed on bolus nasogastric feedings and a lower dose of phenytoin administered between feedings. Adequate seizure control and appropriate phenytoin levels were obtained with no further problems. The recommended management of the phenytoin‐enteral feeding interaction is to flush and clamp the nasogastric tube for 2 hr before and 2 hr after the phenytoin dose. ( Journal of Parenteral and Enteral Nutrition 10: 322–323, 1986)