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December 5, 1966

Fatal Diphenylhydantoin PoisoningA Case Report

JAMA. 1966;198(10):1120-1121. doi:10.1001/jama.1966.03110230136038

DIPHENYLHYDANTOIN is a synthetic compound which has been widely used for more than 25 years as one of the safest anticonvulsant drugs. Fatalities resulting either from untoward reactions with usual doses or from overdoses of the drug are very rare. Search of the literature indicates that only one case has been previously reported in which the fatality occurred from diphenylhydantoin intoxication and resulting central nervous system depression.1

The minor symptoms of acute diphenylhydantoin intoxication include dizziness, tremors, and visual disturbances such as diplopia or mydriasis. More severe symptoms include vomiting, difficulty in swallowing, respiratory distress, fatigue, insomnia, irritability, ataxia, confusion, and hallucinations and delusions.2 There are reports of adults ingesting 4.5, 8.3, and 21.5 gm who subsequently had severe central nervous system depression but eventually recovered.3,4 Renal dialysis was used in two of these patients. Ingestion of as much as 900 mg by a child 2 years