In this section
For 24 hour advice, contact Victorian Poisons Information Centre 131126
Clinical features of phenytoin overdose include neurological and gastrointestinal symptoms. Onset of symptoms is usually within 1 to 2 hours of ingestion, or within minutes if IV administration. There can be a delay by up to five days for the maximal effects following oral ingestion due to zero-order kinetics and prolonged absorption.
All children with deliberate self-poisoning or significant (>20mg/kg OR >10mg/kg greater than the child’s usual daily dose if on a regular dose) accidental ingestion
Any symptomatic child
Acute ingestion of unknown quantity
Any child where the developmental age is inconsistent with accidental poisoning as non-accidental poisoning should be considered.
Intentional overdose or accidental
Co-ingestants eg paracetamol
Always check for Medicalert bracelet in any unconscious patient, or any other signs of underlying medical condition (fingerprick marks etc)
Consider the possibility of co ingestions, either accidental or deliberate
ECG: (particularly if IV administration) initially and repeat at 6 hours until normal.
Phenytoin serum concentration
Paracetamol concentration in all intentional overdoses
Children Requiring Treatment
Moderate-to-severe or persistent symptoms after 6 hours of observation (eg. Depressed conscious state or cardiac arrhythmias)
Admission should be considered for all children and young people with an intentional overdose or in patients with persisting symptoms after 6 hours observation
Consult Contact Victorian Poisons Information Centre 131126 for advice
Children with severe symptoms with the potential to require intensive care review
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.
Period of observation as above
For deliberate ingestion a risk assessment should indicate that the patient is at low risk of further self-harm in the discharge setting
prevention for children Parent
Victorian Poisons Information Centre: 13 11 26 www.austin.org.au/poisons
Intentional self –harm: Referral to local mental health services eg Orygen Youth Health: 1800 888 320
Recreational poisoning: Referral to YoDAA, Victoria's Youth Drug and Alcohol Advice service: 1800 458 685
Last updated January 2018