Plasma Total Phenytoin: A Possibly Misleading Test in Developing Countries
作者:
Carolyn Fedler,
Michael Stewart,
期刊:
Therapeutic Drug Monitoring
(OVID Available online 1999)
卷期:
Volume 21,
issue 2
页码: 155-160
ISSN:0163-4356
年代: 1999
出版商: OVID
关键词: Albumin;Phenytoin;Correction;Monitoring
数据来源: OVID
摘要:
The use of phenytoin has increased among the rural black population in South Africa, many of whom have albumin concentrations below the accepted reference range of 35-50 g/L, related to a combination of malnutrition and late-presenting renal and hepatic disease. Because albumin concentration has a major effect on the proportion of free phenytoin in the extracellular fluid, we instituted a study of the extent of hypoalbuminemia and of the difference between "total" phenytoin (measured by immunoassay), and "corrected" phenytoin (calculated using the Sheiner-Tozer equation, which is based on a mean albumin of 40 g/L). The differences were significant (higher than 20%) in 37% of patients and led us to propose that in populations in which there is a high proportion of patients who are hypoalbuminemic, it is corrected rather than total phenytoin that should be the value reported.
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