Whilst on my A+E attachment I saw a patient brought in status. He was
given lorazepam which failed to stop the seizures. He had been in
before in a similar state and had always previously had sub therapeutic
blood levels of phenytoin, so an infusion was started - this also
failed. Then the results came back and his phenytoin level was through
the roof (taken before the infusion was set up) - is this a case where
paraldehyde should have been used? If a patient is taking phenytoin
anyway should it be used to treat refractory seizures?
Andy morris
Medical Student
Glasgow
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