Treating subtherapeutic phenytoin levels in the ED | Figure 1

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Advanced Practice Registered Nurse

Treating subtherapeutic phenytoin levels in the ED

A 35 yr old male presents to the ED by EMS for alcohol intoxication and possible seizure. VS stable. GCS of 14. + ETOH. Phenytoin level 9. Albumin 3.5. Hx: alcohol abuse, noncompliant with medications.

When discussing how to best care for this pt my preceptor advices 100mg of dilantin IV and then increase his meds.

QUESTIONS:

1. Is there a method of correcting phenytoin levels based off the pt‘s current level? The closest resource I could find was the “top up method“ from the pdf below.
2. As ED providers should we be altering a pt‘s seizure medications?