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2 edition of Phenytoin free-fraction determination in patients with subarachnoid hemorrhage found in the catalog.

Phenytoin free-fraction determination in patients with subarachnoid hemorrhage

Patricia Kim

Phenytoin free-fraction determination in patients with subarachnoid hemorrhage

by Patricia Kim

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  • 14 Currently reading

Published .
Written in English


Edition Notes

Ottawa General Hospital

The Physical Object
Pagination27 p.
Number of Pages27
ID Numbers
Open LibraryOL18641773M

Phenytoin/Phenytoin Sodium Intramuscular Inj Sol: 1mL, 2mL, 5mL, 50mg, mg, mg or subarachnoid hemorrhage†. For seizure prophylaxis following traumatic brain injury† or head trauma† or for seizure prophylaxis or treatment during neurosurgery. The chronic use of phenytoin in patients with epilepsy has been associated with.   The term subarachnoid hemorrhage (SAH) refers to extravasation of blood into the subarachnoid space between the pial and arachnoid membranes. SAH constitutes half of all spontaneous atraumatic intracranial hemorrhages; the other half consists of bleeding that occurs within the brain parenchyma.

patients whoreceived each ofthe sevenphenytoinformulationsfor 4weeks. Plasma phenytoin concentrations The profile for meanplasmaphenytoin concentrations for sampling times during different treatments is shownin the figure. 20 r 18 CDE 16 a 14 c 1 0 C 1 c 10 0 8 6 4L 0 I 2 4 G-on at MSN Academic Search. Protected by copyright. Cardiovascular adverse effects of phenytoin. phenytoin in patients who are treat ed by dopamine infusion. , in subarachnoid. hemorrhage [33] and in traumatic brain injury.

For some of these drugs, however, knowledge of the free fraction is necessary to adapt correct dosing. Phenytoin, with its non-linear pharmacokinetics, >90 % albumin binding and slow elimination rate, is such a drug requiring individualization in patients, especially if rapid intravenous loading and subsequent dose adaptation is needed. To determine the frequency and severity of hypersensitivity reactions to phenytoin, we reviewed 38 cases of proven reactions. Patients were included only if no other drugs, including other anticonvulsants, were in use at the time of the reaction. Rashes were most frequent, followed by fever, lymphadenopathy, eosinophilia, abnormal liver function tests, blood dyscrasias, serum sickness, renal.


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Phenytoin free-fraction determination in patients with subarachnoid hemorrhage by Patricia Kim Download PDF EPUB FB2

The authors then suggested that exposure to phenytoin after subarachnoid hemorrhage should be minimized and argued for a prospective study of phenytoin in patients at high risk for seizures after subarachnoid hemorrhage. We avoid using phenytoin as anticonvulsant prophylaxis in patients with aneurysmal subarachnoid hemorrhage in our center for another by: 9.

Background and Purpose— Phenytoin (PHT) is routinely used for seizure prophylaxis after subarachnoid hemorrhage (SAH), but may adversely affect neurologic and cognitive recovery.

Methods— We studied SAH patients and calculated a “PHT burden” for each by multiplying the average serum level of PHT by the time in days between the first and last measurements, up to a Cited by: Replicate samples analyzed by each method yielded similar values for serum phenytoin free fraction.

Introduction Phenytoin is a phenylated hydantoin derivative used as an anti-epileptic to treat a multitude of seizure disorders. Total serum concentrations of phenytoin correlate with therapeutic efficacy as well as toxicity [1,2].Cited by: Dose should be adjusted to achieve steady-state blood concentration of free phenytoin between and mcg/mL.

The range for percent free phenytoin is 8% to 14%. Severe toxicity occurs when the free phenytoin concentration is > or = mcg/mL. However, response and. The table shows that the phenytoin users had higher mean HDL-cholesterol concentration than the controls.

In 12 patients (43%O) HDL-cholesterol concentrations were above the upper limit of normal (determined as the mean +2SDofcontrol values).

Thehighest concentra-tions were found in the patients who had serum phenytoin concentrationsCited by: 7. After a study of subarachnoid hemorrhage patients, the authors concluded that higher quartiles of phenytoin burden were associated with worse telephone interviews for cognitive status scores.

This study evaluates the changes in seizure rates and adverse events. METHODS: From July to Junepatients with spontaneous subarachnoid hemorrhage were treated. In the first 9 months, 79 patients were administered PHT until discharged from the. Objective The purpose of this study was to identify prognostic factors and build the predictive model based on poor-grade subarachnoid haemorrhage (SAH) population received only supportive symptomatic treatment.

Design Prospective observational cohort study. Setting Intensive care unit at the Clinical Department of Neurology. Participants A total of patients with spontaneous SAH. We present an unusual complication of subarachnoid hemorrhage following injection of phenylephrine in a patient with priapism and sickle cell disease.

Case Report A year-old African American male with a history of sickle cell disease presented to the emergency department with a painful penile erection of greater than 3 hours duration. Phenytoin (PHT) is routinely used for seizure prophylaxis after subarachnoid hemorrhage (SAH), but may adversely affect neurologic and cognitive recovery.

METHODS: We studied SAH patients and calculated a “PHT burden” for each by multiplying the average serum level of PHT by the time in days between the first and last measurements, up.

In both groups, phenytoin total serum concentration only in % of patients (11 patients in Group A and 8 patients in Group B) was in the therapeutic range ( mg/L).

Five (25%) patients in Group A and 2 (%) patients in Group B had sub-therapeutic phenytoin levels. The risk of developing hydrocephalus is associated with the volume of blood within the subarachnoid space and ventricular system. Cerebral vasospasm develops in % of patients, and up to 50% of affected patients die or suffer permanent neurological damage.

Seizures occur in % of patients with SAH. OBJECTIVE: Phenytoin (PHT) is widely administered after subarachnoid hemorrhage, often for several weeks or months.

In addition to known side effects, PHT use has been correlated with cognitive disability and poor outcome. To reduce the rate of PHT com-plications, we converted from a multi-week prophylactic regimen to a 3-day course of treatment.

Background and Purpose-Phenytoin (PHT) is routinely used for seizure prophylaxis after subarachnoid hemorrhage (SAH), but may adversely affect neurologic and cognitive recovery.

Methods-We studied SAH patients and calculated a "PHT burden" for each by multiplying the average serum level of PHT by the time in days between the first and last measurements, up to a.

Subarachnoid hemorrhage can be more easily diagnosed in patients who present with severe symptoms, unconsciousness, or with thunderclap headache, which. Subarachnoid Hemorrhage Rivera-Lara L, Zorrilla-Vaca A, Geocadin R, et al.

Predictors of Outcome With Cerebral Autoregulation Monitoring: A Systematic Review and Meta-Analysis. Crit Care Med. ; Budohoski KP, Czosnyka M, Kirkpatrick PJ, et al.

Clinical relevance of cerebral autoregulation following subarachnoid haemorrhage. Nat Rev Neurol. ; 9;3:   Phenytoin (PHT) is widely administered after subarachnoid hemorrhage, often for several weeks or months.

In addition to known side effects, PHT use has been correlated with cognitive disability and poor outcome. To reduce the rate of PHT complications, we converted from a multi-week prophylactic regimen to a 3-day course of treatment. To the Editor: Dr. Kirshner describes a patient in whom toxicity developed when she switched her daily mg dose of phenytoin from four mg capsules and one mg chewable tablet to nine mg.

Chien A, Liang F, Sayre J, Salamon N, Villablanca P, Vinuela F. Enlargement of small, asymptomatic, unruptured intracranial aneurysms in patients with no history of subarachnoid hemorrhage: the different factors related to the growth of single and multiple aneurysms.

Use in patients with albumin ≤ g/dL (32 g/L). The “Sheiner-Tozer Equation” is the official name of this correction. This updated formula uses an albumin coefficient ofand for patients with renal failure (see Evidence for details).

paHern of hemorrhage is important as patients with this subset of subarachnoid hem­ orrhage have an excellent prognosis. AJNRSeptember/October ; AJR December The distribution of extravasated blood on CT scans in patients with subarachnoid hemorrhage may predict the site of the ruptured aneurysm [1].

Half the patients. This dosing regimen should be reserved for patients in a clinic or hospital setting where phenytoin serum levels can be closely monitored. Patients with a history of renal or liver disease should not receive the oral loading regimen: Initially, 1 gm is divided into 3 doses ( mg, mg, mg) and administered at 2 hour intervals.Schwartz TH, Solomon RA.

Perimesencephalic nonaneurysmal subarachnoid hemorrhage: review of the literature. Neurosurgery ; Rinkel GJ, Wijdicks EF, Hasan D, et al. Outcome in patients with subarachnoid haemorrhage and negative angiography according to pattern of haemorrhage on computed tomography.

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