JOHN W. TURK, M.D., PH.D.; JACK H. LADENSON, PH.D.
TURK JW, LADENSON JH. Phenytoin and Phenobarbital Concentrations in Renal Insufficiency. Ann Intern Med. 1984;101:568-569. doi: 10.7326/0003-4819-101-4-568_2
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Published: Ann Intern Med. 1984;101(4):568-569.
To the editor: It is generally true that immunologic and chromatographic measurements of anticonvulsant drug levels yield equivalent results as stated in Troupin's (1) review. One setting in which this is not the case is renal insufficiency. In that setting, hydroxylated metabolites of phenytoin and phenobarbital accumulate to unusually high levels due to reduced renal clearance rates. The hydroxylated metabolite of phenytoin is not distinguished well from phenytoin by the antibody used in the EMIT assay (SYVA Company, Palo Alto, California) of phenytoin (2-5). A similar situation occurs with the hydroxylated metabolite of phenobarbital and the antibody used in the
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