Abstract
Fosphenytoin is indicated for the treatment of generalized convulsions and seizures occurring during neurosurgery. Metabolites of fosphenytoin include phenytoin, phosphate, and formaldehyde. The drug monograph recommends caution in administering fosphenytoin to patients in whom phosphate restriction is necessary. Additionally, fosphenytoin has altered pharmacokinetics in end-stage renal disease patients. We report a 17-year old African-American male with end-stage renal disease who developed acute hyperphosphatemia to 3.9 mmol/L (12.1 mg/dL) following the intravenous administration of 1000 mg of fosphenytoin for an idiopathic complex partial seizure. To our knowledge, this is the first report of acute hyperphosphatemia due to fosphenytoin administration. Due to this risk of hyperphosphatemia, we recommend that fosphenytoin should be used with caution in the end-stage renal disease population.
Similar content being viewed by others
References
Pfizer Inc (2002) Cerebyx (fosphenytoin sodium injection) [package insert]. Pfizer Inc, NY, pp 1–19
Fischer JH, Patel TV, Fischer PA (2003) Fosphenytoin. Clinical pharmacokinetics and comparative advantages in the acute treatment of seizures. Clin Pharmacokinet 42:33–58
Aweeka FT, Gottwald MD, Gambertoglio JG, Wright TL, Boyer TD, Pollock AS, Eldon MA, Kugler AR, Allredge BK (1999) Pharmacokinetics of fosphenytoin in patients with hepatic or renal disease. Epilepsia 40:777–782
Roberts WL, De BK, Coleman JP, Annesley TM (1999) Falsely increased immunoassay measurements of total and unbound phenytoin in critically ill uremic patients receiving fosphenytoin. Clin Chem 45:829–837
Keegan MT, Bondy LR, Blackshear JL, Lanier WL (2002) Hypocalcemia-like electrocardiographic changes after administration of intravenous fosphenytoin. Mayo Clin Proc 77:584–586
Fujisawa Healthcare, Inc (2003) Prograf (tacrolimus) [package insert]. Fujisawa Healthcare, Inc, Deerfield, IL, pp 1–55
Author information
Authors and Affiliations
Corresponding author
Additional information
This work has been supported in part by the National Institutes of Health, National Center for Research Resources, Grant 1K12RR017613–01
Rights and permissions
About this article
Cite this article
McBryde, K.D., Wilcox, J. & Kher, K.K. Hyperphosphatemia due to fosphenytoin in a pediatric ESRD patient. Pediatr Nephrol 20, 1182–1185 (2005). https://doi.org/10.1007/s00467-005-1947-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-005-1947-0