Clinical Chemistry
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Clinical Chemistry 22: 915-921, 1976;
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Clinical Chemistry, Vol 22, 915-921, Copyright © 1976 by American Association for Clinical Chemistry

Monitoring drug concentrations in a case of combined overdosage with primidone and methsuximide

GF Johnson, CJ Least Jr, JW Serum, EB Solow and HM Solomon

We describe a case of fatal overdosage with primidone and methsuximide. During the early phase of the patient's hospital course we found concentrations of methsuximide, N-desmethylmethsuximide, and primidone in serum that far exceeded the usual therapeutic concentrations, as determined by gas-liquid chromatography. Determination of N- desmethylmethsuximide in peritoneal fluid demonstrated concentrations comparable to those in serum. This led to the therapeutic decision to manage the patient by dialysis. Subsequently, serum samples collected during the course of hospitalization were analyzed quantitatively by gas-liquid chromatography for methsuximide, N-desmethylmethsuximide, primidone, phenobarbital, and diphenylhydantoin. Selected serum specimens were also analyzed by gas chromatography-mass spectrometry, and N-methyl-2-hydroxymethyl-2-phenylsuccinimide, a metabolite of methsuximide not previously described in human serum, was identified by analysis of its mass spectrum.


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 Arch Intern MedHome page
R. W. Baehler, J. Work, W. Smith, and J. A. Dominic
Charcoal Hemoperfusion in the Therapy for Methsuximide and Phenytoin Overdose
Arch Intern Med, November 1, 1980; 140(11): 1466 - 1468.
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Copyright © 1976 by the American Association for Clinical Chemistry.