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In Reply We appreciate the comments provided by Algren and Christian, who contend that phenytoin did not contribute to our presented clinical findings.1
We disagree and are certain that phenytoin use was a major contributor. The classic findings of high-dose, rapid phenytoin administration that they describe are inapplicable to our patient, who was a complex patient with recent liver transplant, status epilepticus, and renal failure, in whom polypharmacy resulted in the electrocardiographic (ECG) changes.
Johnson CJ, Turakhia MP. Phenytoin Toxicity Unlikely to Result in Arrhythmias—Reply. JAMA Intern Med. 2014;174(1):167-168. doi:10.1001/jamainternmed.2013.11168