Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Pharmacy, Tufts University Medical Center, Boston, Massachusetts, USA.
Nutr Clin Pract. 2023 Dec;38(6):1334-1342. doi: 10.1002/ncp.11051. Epub 2023 Aug 3.
Concomitant administration of enteral nutrition (EN) and phenytoin decreases phenytoin absorption. Concerns over impaired nutrition, however, may prevent EN from being held surrounding phenytoin administration. This study aimed to evaluate whether EN holding guidelines impacted nutrition goal achievement in patients taking phenytoin.
Adult patients administered enteral phenytoin for acute or chronic seizures while receiving EN during a neurocritical care admission 6 months before and after EN holding guideline implementation were eligible. Patients without phenytoin concentrations or a clinical registered dietitian assessment were excluded. The primary outcome was the percentage of nutrition daily goals attained before and after implementation. Secondary end points included the incidence of hypoglycemia, differences in measured phenytoin concentrations, and rates of therapeutic (10-20 mcg/ml) and high-therapeutic (15-20 mcg/ml) concentration attainment. Concentrations were adjusted for hypoalbuminemia using the Winter-Tozer equation.
Fifty-five patients representing 412 patient days and 1110 phenytoin administrations were included with 29 preimplementation and 26 postimplementation patients. Median percent attainment of daily EN goals was consistent preimplementation and postimplementation (86% vs 83%, P = 0.48). No significant change in rates of days with hypoglycemia was observed. Adjusted phenytoin concentrations were similar before and after implementation (14.1 vs 15.2 mcg/ml, P = 0.45), but the preimplementation cohort had a lower proportion of high-therapeutic concentrations (23% vs 36%, P = 0.018).
Holding EN for phenytoin did not impact attainment of daily nutrition goals and was not associated with increased rates of hypoglycemia. This is the first study to evaluate the effect of EN holding on nutrition goals in patients receiving phenytoin.
肠内营养（EN）与苯妥英同时给药会降低苯妥英的吸收。然而，由于担心营养受损，可能会阻止在给予苯妥英时暂停 EN。本研究旨在评估 EN 暂停指南是否会影响接受苯妥英治疗的患者的营养目标实现情况。
在神经危重病入院期间接受 EN 治疗的同时接受肠内苯妥英治疗急性或慢性癫痫发作的成年患者，如果在 EN 暂停指南实施前后有苯妥英浓度或临床注册营养师评估，则符合条件。排除没有苯妥英浓度或临床注册营养师评估的患者。主要结局是实施前后营养每日目标的达标率。次要终点包括低血糖的发生率、测量的苯妥英浓度差异以及治疗性（10-20 mcg/ml）和高治疗性（15-20 mcg/ml）浓度达标率。使用 Winter-Tozer 方程对低白蛋白血症进行浓度调整。
共有 55 名患者（412 个患者日和 1110 次苯妥英给药）入选，其中 29 名患者在实施前，26 名患者在实施后。实施前后每日 EN 目标达标率中位数一致（86% vs 83%，P=0.48）。未观察到低血糖天数发生率的显著变化。调整后的苯妥英浓度在实施前后相似（14.1 vs 15.2 mcg/ml，P=0.45），但实施前组高治疗浓度的比例较低（23% vs 36%，P=0.018）。
为了苯妥英而暂停 EN 不会影响每日营养目标的实现，也不会增加低血糖的发生率。这是第一项评估 EN 暂停对接受苯妥英治疗的患者营养目标影响的研究。
