1254

Abstract

was treated with ceftriaxone, vancomycin, azithromycin, and bicarbonate. Potassium and magnesium were replaced. She expired despite all resuscitative measures which included mechanical ventilation and vasopressor support. The majority of tenofovir associated nephrotoxicity has been reported in the HIV population. To our knowledge, this is one of the rare cases reported in a non-HIV patient. The patient's non-anion gap metabolic acidosis, hypokalemia, glucosuria, proteinuria, ketonuria, multiple spontaneous rib fractures and osteopenia were consistent with Fanconi's syndrome. The severity of the acidosis and renal failure likely contributed to this patient's inability to withstand the stress of severe sepsis. Recently the WHO has issued guidelines regarding the management of renal diseases in patients being treated with tenofovir for chronic hepatitis B that include obtaining baseline and biannual renal indices. Tenofovir induced renal failure and Fanconi's syndrome can significantly worsen the prognosis of patient with severe sepsis.