Problems with phenytoin administration in neurology/neurosurgery ITU patients receiving enteral feeding

Our objective was to investigate the relationship between phenytoin bioavai lability, enteral feeding and serum albumin levels in patients admitted to neurology/neurosurgery ITU, via case studies of three patients. The research was performed at the Walton centre for Neurology and Neurosurg ery NHS Trust, Liverpool, England, and our subjects consisted of three case s admitted to ITU (1 status epilepticus, 1 post-trauma and 1 post-subarachn oid haemorrhage (SAH)). Phenytoin levels were assessed in relation to the type of feeding and serum albumin levels. We found evidence of a complex relationship between phenytoin levels, enter al feeding and serum albumin in patients in the neuro ITU setting. We conclude that, in this setting the patient's phenytoin needs to be close ly monitored and treated aggressively to maintain therapeutic levels. They should also be followed up during rehabilitation to avoid toxicity. (C) 200 1 BEA Trading Ltd.