A 22 yr old women in her 8th month of pregnancy is involved

A 22 yr. old women in her 8th month of pregnancy is involved in a motor vehicle accident and suffers a head injury. She is unconscious. Within the first 24 hours of admission to the hospital she has her first grand mal seizure. She is administered 5 mg of IV Diazepam (Valium) and then given a loading dose of IV phenytoin (Dilantin) 800mg followed by 100mg phenytoin IV every 6 hours. Other orders include, phenytoin levels qd, cimetidine 300mg IV BID, and prn diazepam 5 mg IV for breakthrough seizures.

If this patient was kept on phenytoin after discharge and after giving birth, what specific patient education items would you need to inform her of? cite references

Solution

If she was only on Tab phenytoin, the levels in her breast milk would be small and she need not worry about it affecting the baby. However if she was on other psychotropics or anticonvulsants along with phenytoin, the baby may experience withdrawl reaction or sedation. Therefore it is important for her to test her phenytoin levels to monitor that it would not cross the toxic levels.

When a pregnant woman is on phenytoin, there is increased risk for the baby to develop fetal hydantoin syndrome where there will be some congenital anomalies to the baby.

Some children develop some coagulation defects which is treatable with vitamin K.

There are some other precautions such as: