Phenytoin
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Phenytoin | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
PHENY
Test Workstation :
ACHM5
Specimen Type:
Blood
Tube Type:
Green top (lithium heparin) tube
Minimum Volume:
500 uL
Preferred Volume:
1.5 mL
Storage:
Shipping- Send Refrigerated; Storage-Refrigerated: 4 days; Frozen: 1 month
Availability:
24 hours/day, 7 days/week
Methodology:
Roche-KIMS
Special Instructions:
For therapeutic monitoring, draw peak levels 24 hours postIV infusion(loading dose) or 39 hours postoral ingestion and trough levels immediately prior to next dose. Due to the observed crossreactivity of this assay to fosphenytoin, it is recommended that samples for serum phenytoin measurements be collected at least 2 hours after an intravenous dose of fosphenytoin and at least 4 hours after an intramuscular dose.
Lab/Phone:
330-543-8418
TAT:
1 hour
Additional Info:
Therapeutic range: 10.0-20.0 ug/mL
CPT Code:
80185
Synonyms:
Dilantin; Diphenylhydrantoin
