Objective: IV Fosphenytoin loading dose at 20 mg/kg is preferred in management of status epilepticus in children . This study was done to see if adequate serum Phenytoin levels are achieved , its efficacy (seizure control) and tolerability (adverse effects).

Design: Prospective analytical study.

Setting and Participants: Children admitted  with status epilepticus, loaded with IV Fosphenytoin at the dose of 20 mg/kg .

Intervention and Outcome measures: A serum sample was collected at 90 minutes after loading dose to estimate Phenytoin levels by CLIA method. A clinical note of control of seizures, possible etiology, need of further anticonvulsant, toxicity etc. were recorded.

Results:

51 patients admitted between October 2016 to September 2017 were included. The mean dose of fosphenytoin received was 20.22 mg/kg (15.15 to 25 mg/kg). Serum Phenytoin levels were in therapeutic range (10-20 microgram/mL) in 23.5%, sub-therapeutic in 31% and in toxic range in 48% children.  Seizures did not respond in five children: one of whom had sub-therapeutic level and 2 each had  therapeutic and supra-therapeutic levels.

Conclusion: 20 mg/kg of IV Fosphenytoin is safe and effective in controlling status epilepticus in 90.5% . irrespective of serum phenytoin levels. Hence,  monitoring of serum phenytoin levels may not be routinely required in Indian children.