Intermittent hemodialysis treatment in cefepime‐induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature

We report the case of an 88‐year‐old female patient with impaired renal function who developed life‐threatening neurologic symptoms during cefepime therapy. She was treated with two intermittent 3‐hour high‐flux, high‐efficiency hemodialysis sessions. Serial pre‐, post‐, and peridialytic (pre‐ and postfilter) serum cefepime concentrations were measured. Pharmacokinetic modeling showed that this dialytic strategy allowed for serum cefepime concentrations to return to the estimated nontoxic range 15 hours earlier than would have been the case without an intervention. The patient made a full clinical recovery over the next 48 hours. We conclude that at least 1 session of intermittent hemodialysis may shorten the time to return to the nontoxic range in severe clinically patent intoxication. It should be considered early in its clinical course pending chemical confirmation, even in frail elderly patients. Careful dosage adjustment and a high index of suspicion are essential in this population.

Source: Hemodialysis International - July 22, 2014 Category: Hematology Authors: Laila‐Yasmin Mani, Sébastien Kissling, Dragana Viceic, Bruno Vogt, Michel Burnier, Thierry Buclin, Delphine Renard Tags: Case Report Source Type: research