ESPN 50th Annual Meeting

ESPN 2017


 
Life threatening arrhythmia and non-convulsive status related to cefepim in a patient with chronic renal failure
SEYDA KOSE OZCAN 2 ALIYE GULBAHCE 2 Emine Azak 1 SEYMA ERTEM 2 AYDAN DEGERLIYURT 2 UMUT SELDA BAYRAKCI 1

1- ANKARA YILDIRIM BEYAZIT UNIVERSITY DEPARTMENT OF PEDIATRIC NEPHROLOGY
2- ANKARA CHILD HEALTH HEMATOLOGY ONCOLOGY RESEARCH AND TRAINING HOSPITAL
 
Introduction:

 Cephalosporins, particularly cefepime, exert neurotoxic side effects that can lead to status epilepticus. These neurotoxic side effects include myoclonus, dystonic movements, tremor, asterixis, seizure, status epilepticus, encephalopathy, and sometimes coma. Status epilepticus, particularly nonconvulsive status epilepticus (NCSE), is a well-known but unusual complication in patients with altered renal function who were receiving treatment with intravenous cephalosporins, especially cefepime. Cardiotoxicity due to cephalosporins is not reported yet

Material and methods:

 Here we report a chronic peritoneal dialysis patient who received cefepime for peritonitis.

Results:

 He developed tremor and asterixis on the 6 th day of treatment. His electroencephalography revealed status epilepticus and considered to be in a state of non-convulsive status. Electrocardiography revealed frequent ventricular extrasistoles, while his echocardiographic examination revealed slight ventricular hypertrophy. Cefepime was discontinued immediately. His neurological symptoms subsided in 24 hours while arrhythmia subsided in a week. 

Conclusions:

 Nonconvulsive status epilepticus was observed between 2 and 8 days (average of 5.6 days) after initiation of cephalosporins. Cephalosporins are epileptogenic drugs, especially when used in excessive doses or when renal function is impaired. Critically ill patients with chronic kidney disease are particularly susceptible to cefepime neurotoxicity. However, there is not any reported case related to cardiotoxicogenic or arrhythmogenic affect of cefepime in literature. Cefepime should be used carefully in patients with renal failure. Its neurotoxic and arrhythmogenic affect should be kept in mind.