A junctional rhythm with retrograde conduction and bradycardia as a dysrhythmia caused by oral phenytoin toxicity
Arroyo, P.; Ortiz Nolasco, R.; Godoy López, M.; Garcia Gubern, C.; Rivera, V.
Boletin de la Asociacion Medica de Puerto Rico 96(3): 134-138
2004
ISSN/ISBN: 0004-4849 PMID: 15803967 Document Number: 8126
Phenytoin toxicity is associated with varying degrees of altered mental status which ranges from subtle changes to stupurous and comatous states. Also it is associated with seizures and the occurrence of serious cardiac dysrhythmias. This cardiotoxic effects have been attributed exclusively to IV administration of phenytoin at high rates. Although oral phenytoin overdose has not been traditionally associated with cardiac toxicity, high serum levels of phenytoin can potentially predispose a patient to dangerous cardiac dysrhythmias. (2) We report a case of a patient unintentionally intoxicated with oral phenytoin presenting to a community based hospital with an altered mental status and bradycardia unresponsive to IV atropine. This particular case challenges the previous belief that cardiotoxicity of phenytoin was exclusive to IV administration.
Document emailed within 1 workday
