Injection: The lethal dose for adults is estimated to be 2 to 5 grams. Initial symptoms include nystagmus, ataxia and dysarthria. The patient may become comatose, pupils unresponsive and hypotension occurs. Death is due to respiratory depression and apnea. treatment is nonspecific since there is no known antidote. If the gag reflex is absent, the airway should be supported by oxygen. Vasopressors and assisted ventilation may be necessary for central nervous system, respiratory and cardiovascular depression. Finally, hemodialysis may be considered, since Phenytoin is not completely bound to plasma proteins. Total exchange transfusion can be utilized in the treatment of severe intoxication in children.
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