ABSTRACT
For each important type of drug toxic emergency, available information on predisposing risks, incidence, detection (clinical and laboratory), management (monitoring, specific therapy, modification of antiepileptic drug regimen), and outcome will be reviewed. Methods and timing of reinstitution of antiepileptic medications after overdose is a matter of some discussion. In 1987, 2577 cases of phenytoin (PHT) overdosage were reported in the United States, with 4 deaths. Patients routinely requiring high doses for seizure control are at particular risk. Iatrogenic poisoning occurs easily due to saturation pharmacokinetics of PHT metabolism. The earliest and most reliable indicator of developing clinical toxicity from PHT overdose is accurate reporting by the patient of symptoms. A specific association of valproate (VPA) therapy and idiosyncratic isolated hepatic failure, in the absence of systemic hypersensitivity, has been studied and reviewed recently by Dreifuss et al. Acute hemorrhagic pancreatitis rarely has been associated with VPA therapy.
