Focal seizures: Mainly used to protect against the development of focal seizures with complex symptomatology (psychomotor and temporal lobe seizures). Also effective in controlling focal seizures with autonomic symptoms. Absence seizures: Not used in treatment of pure absence seizures due to risk for increasing frequency of seizures. However, can be used in combination with other anticonvulsants during combined absence and tonic-clonic seizures. Seizures during surgery: A 2018 meta-analysis found that early antiepileptic treatment with either phenytoin or phenobarbital reduced the risk of seizure in the first week after neurosurgery for brain tumors. Status epilepticus: Considered after failed treatment using a benzodiazepine due to slow onset of action. Other
Abnormal heart rhythms: may be used in the treatment of ventricular tachycardia and sudden episodes of atrial tachycardia after other antiarrhythmic medications or cardioversion has failed. It is a class 1b antiarrhythmic. Digoxin toxicity: Intravenous formulation is drug of choice for arrhythmias caused by cardiac glycoside toxicity. Trigeminal neuralgia: Second choice drug to carbamazepine. Special considerations
Phenytoin has a narrow therapeutic index. Its therapeutic range for an anticonvulsant effect is 10–20 μg/mL and for an antiarrhythmic effect 10–20 μg/mL. The most common cause of phenytoin intoxication is self‑medication, which accounts for more than thirty percent of the cases. Avoid giving intramuscular formulation unless necessary due to skin cell death and local tissue destruction. Elderly patients may show earlier signs of toxicity. In the obese, ideal body weight should be used for dosing calculations. Pregnancy: Pregnancy category D due to risk of fetal hydantoin syndrome and fetal bleeding.
This indicates that the fetus passed the meconium some time ago such that sufficient mixing occurred as to establish the homogeneous mixture. Terminal meconium occurs when the fetus passes the meconium a short enough time before birth/cesarean section that the amniotic fluid remains clear, but individual clumps of meconium are in the fluid. Failure to pass meconium
The failure to pass meconium is a symptom of several diseases including Hirschsprungs disease and cystic fibrosis. The meconium sometimes becomes thickened and congested in the intestines, a condition known as meconium ileus. Meconium ileus is often the first sign of cystic fibrosis. In cystic fibrosis, the meconium can form a bituminous black-green mechanical obstruction in a segment of the ileum. Beyond this, there may be a few separate grey-white globular pellets. Below this level, the bowel is a narrow and empty micro-colon. Above the level of the obstruction, there are several loops of hypertrophied bowel distended with fluid. No meconium is passed, and abdominal distension and vomiting appear soon after birth. About 20% of cases of cystic fibrosis present with meconium ileus, while approximately 20% of one series of cases of meconium ileus did not have cystic fibrosis. The presence of meconium ileus is not related to the severity of the cystic fibrosis. The obstruction can be relieved in a number of different ways.Meconium ileus should be distinguished from meconium plug syndrome, in which a tenacious mass of mucus prevents the meconium from passing and there is no risk of intestinal perforation.