The patient, in this case, is currently suffering from persistent diarrhea. His physician orders lab work,...

The patient, in this case, is currently suffering from persistent diarrhea. His physician orders lab work, including a phenytoin level as he also suffers from a seizure disorder. His serum phenytoin levels are low, so the physician increased his dose so his serum levels fell within the therapeutic range. After the diarrhea resolved, the patient suffered a seizure.

Questions:

1. What is the most probable cause of the initial low phenytoin level?

2. What assays other than the serum phenytoin level would aid in this situation?

3. What is the most probable cause of the seizure after the diarrhea has been resolved?

Solutions

Expert Solution

1) The most probable cause of the initial low phenytoin level are disscussed below-

Here the patient also had seizure..so,he was under the phenytoin therapy..

The normal level of phenytoin in the blood is- 10-20 mcg/mL.. In this case the patient is suffering from persistant diarrhea..So, for this condition fluid electrolyte balance is not normal..

2) when the dose of phenytoin is increasd,, the level of phenytoin in the blood is also increased..

And we know when the level of phenytoin in the blood is increased, the chance of developing seizure activity is also increased.. Apart from this many side effects of the phenytoin ( like-Headache,Dizziness ,involuntary & rapid eye movement ) is also developed..

3) In the above condition After the resolve of diarrhea ,, the patient has developed seizure because-

The patient had already seizure condition..So, the patient was under the medication phenytoin..for the disease diarrhea the blood level of phenytoin was decreased..So, the dosage of phenytoin was increased ..But for this treatment excess amount of phenytoin is accumulated in the blood..That causes the further seizure attack..

Nightingale answered 2 years ago

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