24 January 2022: Articles
Prolonged Cefepime-Induced Neurotoxicity in a Patient with End-Stage Renal Disease
Unusual clinical course, Adverse events of drug therapy, Clinical situation which can not be reproduced for ethical reasons
Dorothy Dao Nguyen A* , Samuel Lai DDOI: 10.12659/AJCR.934083
Am J Case Rep 2022; 23:e934083
Table 2. Summary and timeline of major clinical events, with associated laboratory values and pharmacologic interventions.
| Time | Clinical event | Associated laboratory values | Pharmacologic intervention | Notes |
|---|---|---|---|---|
| Admission #1 | RUE AV graft infection | WBC 13.3×10 cells/LNa 135 mEq/LK 6.1 mEq/LCO2 22 mg/dLCr 8.6 mg/dLBUN 56 mg/dLGlu 117 mg/dLCa 8.2 mEq/L | Cefepime | Noted to have some confusion after |
| Day #1 after admission | WBC 7.6×10 cells/LNa 139 mEq/LK 3.7 mEq/LCO2 29 mg/dLCr 5.1 mg/dLBUN 30 mg/dLGlu 131 mg/dLCa 8.1 mEq/L | Cefepime switched to Meropenem | Status post resection and ligation of RUE AV graft, washout, and partial closure, hemodialysis. Patient responded to Meropenem for prior infections, change made | |
| Day #15 after admission | Discharge | WBC 8.7×10 cells/LNa 139 mEq/LK 4.2 mEq/LCO2 29 mg/dLCr 3.6 mg/dLBUN 36 mg/dLGlu 88 mg/dLCa 8.8 mEq/L | Cefepime | Per Infectious Diseases consult, patient back on Cefepime. Discharged on Cefepime |
| Admission #2 | Encephalopathy | WBC 8.2×10 cells/LNa 141 mEq/LK 4.7 mEq/LCO2 26 mEq/LCr 5.7 mg/dLBUN 20 mg/dLGlu 95 mg/dLCa 9.4 mEq/L | Cefepime switched to Piperacillin/Tazobactam | Patient’s condition attributed to Cefepime neurotoxicity |
| Day #2 after admission | Seizures | WBC 6.6×10 cells/LNa 142 mEq/LK 4.4 mEq/LCO2 26 mEq/LCr 8.3 mg/dLBUN 43 mg/dLGlu 93 mg/dLCa 8.2 mEq/L | Levetiracetam, Lorazepam. Piperacillin/Tazobactam switched to Meropenem | Meropenem was to cover for empiric meningitis and patient’s continued antibiotic course for her prior infection |
| Day #2 after admission | Entered Neuro ICU, where patient was hypotensive, suspicion for meningoencephalitis | Acyclovir, Vancomycin | Later discontinued with lower suspicion for meningoencephalitis | |
| Day #6 after admission | Hemodialysis | |||
| Day #7-8 after admission | Improvement in mental status | WBC 4.4×10 cells/LNa 139 mEq/LK 4.0 mEq/LCO2 24 mEq/LCr 5.0 mg/dLBUN 20 mg/dLGlu 84 mg/dLCa 8.4 mEq/L | ||
| Day #7 after admission | CVA on MRI | Aspirin | Thought less likely cause of encephalopathy | |
| Day #20 after admission | Discharge | WBC 6.3×10 cells/LNa 136 mEq/LK 4.0 mEq/LCO2 26 mEq/LCr 3.9 mg/dLBUN 17 mg/dLGlu 88 mg/dLCa 8.1 mEq/L | Patient completed course of Meropenem outpatient, remained seizure-free and showed no signs of encephalopathy |