Anticonvulsant hypersensitivity: an unfortunate case of triple exposure to phenytoin

Journal of Family Practice, Nov, 1997 by Cara E. Brown, Gregory D. Smith, Thomas Coniglione

This case exemplifies the importance of remaining the patient's advocate in spite of difficult psychosocial situations, especially when life-threatening conditions exist. Her circumstances demonstrate several psychosocial barriers to identification of important medical conditions including: (1) the patient's inability to comprehend and communicate adequately; (2) the family's failure to comprehend and communicate adequately; (3) lack of continuity of care. Common patient populations with barriers to condition identification include children, demented patients, mentally retarded patients, post-ictal individuals, comatose patients, patient's in status epilepticus, family neglect or absence. and patients on vacation, moving or traveling.

With our case study patient, we have thus far been able to honor the patient's request to live with her daughter by finding other mechanisms to deliver her medication and to communicate her allergy. Recently, her carbemazepine level was reported in the normal range. Our hopes are that her seizure disorder will remain controlled and that she will never again be subjected to the lethal risk of phenytoin administration.

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