Hyperphosphatemia due to fosphenytoin in a pediatric ESRD patient

  title={Hyperphosphatemia due to fosphenytoin in a pediatric ESRD patient},
  author={Kevin D. McBryde and Jennifer E. Wilcox and Kanwal K. Kher},
  journal={Pediatric Nephrology},
Fosphenytoin is indicated for the treatment of generalized convulsions and seizures occurring during neurosurgery. Metabolites of fosphenytoin include phenytoin, phosphate, and formaldehyde. The drug monograph recommends caution in administering fosphenytoin to patients in whom phosphate restriction is necessary. Additionally, fosphenytoin has altered pharmacokinetics in end-stage renal disease patients. We report a 17-year old African-American male with end-stage renal disease who developed… 
It is shown that intravenous fosphenytoin has a similar adverse effect profile than phenytoin when it is administered as recommended, and there is no evidence of clear benefit that would justify the higher price of the fospennytoin compared to pheny toin.
The safety and efficacy of fosphenytoin for the treatment of status epilepticus
The main indications for fosphenytoin are the treatment of convulsive status epilepticus and the prevention/management of seizures during neurosurgery and avoiding complications associated with parenteral use of phenytoin.
Use of Antiepileptic Drugs in Patients with Kidney Disease
For both the older and newer AEDs, basic pharmacokinetic information, recommendations for drug dosing in patients with reduced kidney function or who are on dialysis, and adverse renal and fluid‐electrolyte effects are reviewed.
Could There Be an Alternative Explanation for Cardiomyopathy in an Infant Following Fosphenytoin Overdose?
The authors are asked to provide electrocardiogram and serum calcium and phosphate concentrations and the temporal relationship to the medication error is evident, and omitted data points may help clarify the exact etiology of the cardiovascular compromise.
Anticonvulsant Medications in the Pediatric Emergency Room and Intensive Care Unit
New data regarding anticonvulsants that are useful in these settings, including fosphenytoin, valproic acid, levetiracetam, and topiramate are discussed, and a status epilepticus treatment algorithm is suggested, incorporating changes from traditional algorithms based on these new data.
Use of Antiepileptic Drugs in Patients with Chronic Kidney Disease and End Stage Renal Disease
This is a review of the most commonly prescribed AEDs with special focus on their indication, pharmacokinetics, and unique considerations for use in patients with CKD and ESRD.
Extracorporeal Treatment in Phenytoin Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup
This work aims to provide a forward-looking view on the development and use of nanofiltration technology in the personalized medicine setting and its applications in the context of regenerative medicine.
Spurious hyperphosphatemia in a patient with alteplase-locked central venous catheter
Alteplase has been shown to be effective in preventing central venous access clotting in patients on hemodialysis. Because of a high phosphorus content in its excipient, it can inadvertently
Pharmacotherapy in the Critically Ill Child with Acute Kidney Injury
Renal replacement therapy can affect the drug levels of commonly used medications in the PICU.


Hypocalcemia-like electrocardiographic changes after administration of intravenous fosphenytoin.
The case of a 23-year-old man with a known but untreated seizure disorder who was given prophylactic fosphenytoin, 1500-mg phenytoin equivalents over 85 minutes by intravenous infusion produced electrocardiographic changes consistent with hypocalcemia, and these changes were associated with new-onset reductions in both total and ionized serum calcium concentrations.
Fosphenytoin: clinical pharmacokinetics and comparative advantages in the acute treatment of seizures.
The pharmacokinetic properties of fosphenytoin permit the drug to serve as a well tolerated and effective alternative to parenteral phenytoin in the emergency and non-emergency management of acute seizures in children and adults.
Pharmacokinetics of Fosphenytoin in Patients with Hepatic or Renal Disease
The first study of the effect of hepatic or renal disease on the rate and extent of conversion of FOS to PHT, the water‐soluble prodrug of phenytoin, has been characterized in normal subjects.
Falsely increased immunoassay measurements of total and unbound phenytoin in critically ill uremic patients receiving fosphenytoin.
These results are consistent with the formation of one or more novel metabolites or adducts of fosphenytoin that accumulate in some critically ill patients with renal insufficiency and that display significant cross-reactivity with some, but not all, phenytoin immunoassay methods.