Abstract
The details of two consecutive admissions of a diabetic, epileptic patient are presented. Anticonvulsant serum level monitoring documented a decline in both phenobarbital and phenytoin concentrations during both episodes of diabetic ketoacidosis. These periods of reduced serum anticonvulsant concentrations coincided with increased seizure activity. Urine analysis revealed a dramatic increase in the excretion rate of phenobarbital. The urinary excretion rate of unchanged phenytoin was also markedly increased by diuresis, but the percent of the dose removed via this pathway remained small. These results dictate frequent serum concentration monitoring in patients afflicted with both diabetes and epilepsy.
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