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Use of phenytoin serum levels in a case of status epilepticus

From the Department of Neurology, University Hospitals, Iowa City, Iowa.

Serum anticonvulsant determinations made possible the identification of an unusual cause of status epilepticus and assisted with appropriate therapy in an epileptic patient with second-degree burns. The seizures were associated with a serum phenytoin concentration of 3.5 µg per milliliter. This suboptimal concentration of drug developed despite continuation of the patient's customary oral dose of phenytoin. The patient's response to intravenous phenytoin led to the conclusion that the unexpected decrement in serum anticonvulsant concentration was related to an impairment in absorption of that drug, possibly caused by the concurrent administration of oral oxacillin.

Requests for reprints should be addressed to Dr. Fincham, Department of Neurology, University Hospitals, Iowa City, IA 52242.

Received for publication June 23, 1975.