ICNC Abstracts, ICNC 2018

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Intravenous Fosphenytoin loading dose of 20 mg/kg in Status epilepticus: Is it enough in Indian children?
Kavita Srivastava

Last modified: 2018-09-09


Objective: IV Fosphenytoin loading dose at 20 mg/kg is preferred in management of status epilepticus in children . This study was done to see if adequate serum Phenytoin levels are achieved , its efficacy (seizure control) and tolerability (adverse effects).

Design: Prospective analytical study.

Setting and Participants: Children admitted  with status epilepticus, loaded with IV Fosphenytoin at the dose of 20 mg/kg .

Intervention and Outcome measures: A serum sample was collected at 90 minutes after loading dose to estimate Phenytoin levels by CLIA method. A clinical note of control of seizures, possible etiology, need of further anticonvulsant, toxicity etc. were recorded.


51 patients admitted between October 2016 to September 2017 were included. The mean dose of fosphenytoin received was 20.22 mg/kg (15.15 to 25 mg/kg). Serum Phenytoin levels were in therapeutic range (10-20 microgram/mL) in 23.5%, sub-therapeutic in 31% and in toxic range in 48% children.  Seizures did not respond in five children: one of whom had sub-therapeutic level and 2 each had  therapeutic and supra-therapeutic levels.

Conclusion: 20 mg/kg of IV Fosphenytoin is safe and effective in controlling status epilepticus in 90.5% . irrespective of serum phenytoin levels. Hence,  monitoring of serum phenytoin levels may not be routinely required in Indian children.


Fosphenyton; Phenytoin levels; children; status epilepticus; loading dose

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