Question

The medical team is at bedside and reviewing the below lab results. Frankie has been seizing for 3 minutes.

N: 130 K: 5.2 Chloride: 92 BUN: 80 Creatinine : 0.82 Glucose: 58

Phenytoin Level: 4 mcg/ml (10-20 mcg/mL) Levetiracetam level: 10 mcg/ml (12.0 - 46.0 mcg/mL)

You receive the following orders to complete:

•Normal Saline bolus 20ml/kg IV now (Available in 1000ml bags)

•Dextrose 25% 2 ml/kg IV now (Available in 100 ml vials)

•Phenytoin 20mg/kg IV Now (Available in 250mg/5ml)

•Lorazepam 0.1 mg/kg IV Now (Available in 20mg/10 ml)

Which order is your priority order? Why? How many ml will you administer for that order?

Answer 1

Phenytoin 20mg/kg IV Now (Available in 250mg/5ml)

Phenytoin is indicated for controlling generalized tonic–clonic (grand mal) and complex partial (psychomotor, temporal lobe) seizures and for preventing and treating seizures occurring during or following neurosurgery. The primary site of action appears to be the motor cortex, where the drug inhibits the spread of seizure activity. Possibly by promoting sodium efflux from neurons, phenytoin tends to stabilize the threshold against hyperexcitability caused by excessive stimulation or environmental changes capable of reducing membrane sodium gradient; this activity includes reducing post-tetanic potentiation at synapses. Loss of post-tetanic potentiation prevents cortical seizure foci from detonating adjacent cortical areas. Phenytoin reduces the maximal activity of brainstem centers responsible for the tonic phase of tonic–clonic seizures.