The binding of phenytoin to albumin is temperature dependent. Coleman et al developed an equation for estimating the free phenytoin concentration at 37°C based on the level seen in the laboratory at 25°C.
free phenytoin concentration at 37°C =
= (1.19 * (free phenytoin concentration at 25°C)) + 0.166
This makes me wonder if the free phenytoin concentration would be even higher in a patient with fever.
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