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Delayed Onset of Profound Coma

Steven B. Karch, MD

JAMA. 1973;223(13):1463-1465.

Abstract
To my knowledge, this is the third reported case of methsuximide overdosage. The resulting disorder is biphasic in nature, an apparently benign phase preceding deep coma by a variable number of hours. This sequence, unless anticipated, may lead to potentially lethal results in what otherwise should be a benign condition. The plasma half-life of methsuximide is less than three hours, but a metabolite, 2-methyl-2-phenyl-succinimide, was detected at high levels in the blood of our patient 60 hours postingestion, while the patient was still deeply comatose. The deep coma produced by overdose with methsuximide may be due to the continuing presence of its metabolite, and not to the drug itself. Similar arguments may apply to the antiseizure activity as well.

Author Affiliations
From the Department of Neurology, Stanford University, Stanford, Calif.

Footnotes
Reprint requests to Department of Neurology, Stanford University, Stanford, Calif 94305 (Dr. Karch).

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