History A 19-month-old male presents to the emergency department with his parents after ingesting 35 mL of phenytoin suspension. Parents narrate that he appears to be “wobbly” and “sleepy”. He has had no vomiting and no seizure activity. Past Medical History Brain aneurysm, seizure disorder, feeding disorder. Physical Examination Temperature: 100.4°F Heart Rate: 132 bpm Respiratory Rate: 30 breaths per minute BP: 110/70 mmHg General: He appears very sleepy but is arousable and has an intact gag reflex. HEENT: Examination reveals horizontal and vertical nystagmus. Mouth examination reveals gingival hyperplasia.
Pulmonary: Clear to auscultation. Cardiovascular examination: Regular rate and rhythm without murmur, capillary refill normal. Neurologic: Glasgow coma scale (GCS)= 15, cranial nerves II-XII intact. Truncal ataxia is present. Hyperreflexia present. What initial therapy should be…
