Sabu Joel, Madapat Kevin Jose, Baby Namitha K
Internal Medicine, Father Muller Medical College, Mangaluru, India.
JSS College of Pharmacy, Mysuru, India.
SAGE Open Med Case Rep. 2025 Jul 27;13:2050313X251357786. doi: 10.1177/2050313X251357786. eCollection 2025.
Phenytoin is a widely prescribed antiepileptic drug that is associated with various adverse effects, but gastrointestinal manifestations are rare. Therapeutic drug monitoring is essential for ensuring safe and effective dosing by measuring the drug levels in the blood. We present the case of a 65-year-old individual with a history of seizure disorder, hypertension, and stable chronic kidney disease, who presented with acute abdominal distension and constipation. Imaging studies revealed acute colonic pseudo-obstruction, while serum phenytoin levels were elevated at 25.6 μg/mL (therapeutic range: 10-20 µg/mL). The patient's symptoms resolved following gradual tapering of phenytoin and initiation of levetiracetam over 2 weeks. This case highlights a rare presentation of phenytoin toxicity manifesting as Ogilvie syndrome and underscores the importance of therapeutic drug monitoring and early recognition of gastrointestinal symptoms in patients on phenytoin therapy.
苯妥英钠是一种广泛使用的抗癫痫药物，它会引发各种不良反应，但胃肠道表现较为罕见。治疗药物监测对于通过测量血液中的药物水平来确保安全有效的给药剂量至关重要。我们报告了一例65岁的患者，有癫痫病史、高血压和稳定的慢性肾病，出现急性腹胀和便秘。影像学检查显示急性结肠假性梗阻，而血清苯妥英钠水平升高至25.6μg/mL（治疗范围：10 - 20μg/mL）。在2周内逐渐减少苯妥英钠剂量并开始使用左乙拉西坦后，患者症状得到缓解。该病例突出了苯妥英钠毒性罕见地表现为奥吉尔维综合征，并强调了治疗药物监测以及对接受苯妥英钠治疗患者胃肠道症状的早期识别的重要性。
