Cefepime-Induced Encephalopathy: A Possible Additional Mechanism of Neurotoxicity

Fernández–Fernández, Francisco José; Ameneiros-Lago, Eugenia

doi:10.1007/s12028-019-00894-2

Cited by 2 publications

(2 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hypocarnitinemiaassociated encephalopathy has been reported with cefditoren, another cephalosporin, and carnitine deficiency may also be responsible for CIN through the inhibition of an organic cation/carnitine transporter gene (OCTN2) which could lead to an increased urinary loss of carnitine. [10][11][12][13] The neurotoxic effects may manifest as altered mental status, reduced consciousness, confusion, myoclonus, aphasia, agitation, seizures, and non-convulsive status epilepticus. 5 Unfortunately, critically ill patients may have similar neurological manifestations from infection, postoperative state, electrolyte disturbances, hypoglycemia, shock, alcohol withdrawal, pain, hypercapnia, and hypoxemia making it challenging to determine the true etiology of encephalopathy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cefepime Induced Neurotoxicity Following A Regimen Dose-Adjusted for Renal Function: Case Report and Review of the Literature

et al. 2021

View full text Add to dashboard Cite

Introduction: Cefepime induced neurotoxicity (CIN) is commonly associated with renal dysfunction, however CIN can occur in patients with normal renal function or renally dose-adjusted regimens. Few reports of this kind have obtained cefepime concentrations to assist in diagnosis. Patient Case: A 42-year old female with a complex past medical history was transferred to our facility with chief complaint of worsening shock and respiratory failure, and the patient was also noted to be hypernatremic, experiencing diabetic ketoacidosis (DKA), and acute kidney injury (AKI). Her DKA resolved and hypernatremia and AKI began to improve. As a result, cefepime was dose-adjusted for renal function estimated by the Cockcroft-Gault (CG) equation. Her hospital course was complicated by persistent altered mental status (AMS), preventing extubation. Cefepime was discontinued due to concern for CIN, and a concentration was obtained 13-hours after the last dose which was elevated at 49 µg/mL. Two days following cefepime discontinuation, the patient’s mental status improved allowing for successful extubation. The patient remained stable and was discharged to an acute care floor and then ultimately back to home. Conclusion: CIN should be part of a wider differential diagnosis for patients experiencing encephalopathy, and inaccurate renal function estimation may be a risk factor for developing CIN. Furthermore, therapeutic drug monitoring (TDM) may serve as an important clinical tool in diagnosing and managing CIN.

show abstract

Section: Introductionmentioning

confidence: 99%

“…Hypocarnitinemia-associated encephalopathy has been reported with cefditoren, another cephalosporin, and carnitine deficiency may also be responsible for CIN through the inhibition of an organic cation/carnitine transporter gene (OCTN2) which could lead to an increased urinary loss of carnitine. 10-13…”

Section: Introductionmentioning

confidence: 99%

Cefepime Induced Neurotoxicity Following A Regimen Dose-Adjusted for Renal Function: Case Report and Review of the Literature

et al. 2021

View full text Add to dashboard Cite

show abstract

Prolonged Cefepime-Induced Neurotoxicity in a Patient with End-Stage Renal Disease

Nguyen

Lai

2021

Am J Case Rep

View full text Add to dashboard Cite

Patient: Female, 86-year-old Final Diagnosis: Drug reaction Symptoms: Encephalopathy • seizure Medication: — Clinical Procedure: — Specialty: Neurology Objective: Unusual clinical course Background: Cefepime, a fourth-generation cephalosporin, has a known adverse effect of neurotoxicity. It occurs notably in patients with end-stage renal disease, but symptom resolution typically occurs within a median of 2 days following drug discontinuation. Case Report: We present a patient with end-stage renal disease on hemodialysis (TWThSat) who developed prolonged neurotoxicity lasting longer than 1 week complicated by nonconvulsive status epilepticus 2 days after cefepime discontinuation. She presented initially with a right upper-extremity arteriovenous graft infection from extended-spectrum beta-lactamase Escherichia coli , and was treated with cefepime. She eventually developed acute encephalopathy, and cefepime was discontinued. However, 2 days later, she developed seizures with worsened mental status. She was stabilized on levetiracetam and lorazepam, but developed hypotension in the Neurological Intensive Care Unit (Neuro-ICU), delaying hemodialysis. Hemodialysis was performed 6 days after cefepime discontinuation once she was stabilized, and her mental status improved 1 to 2 days after, with full improvement 20 days after admission. She was discharged on levetiracetam and meropenem. In addition, we review risk factors and symptomology of cefepime-induced neurotoxicity and discuss important management issues. Conclusions: Careful attention should be paid when administering cefepime to patients with end-stage renal disease. Patients showing signs of encephalopathy should not be on cefepime any longer, and more aggressive measures may be taken, such as prompt hemodialysis, assessment of cefepime blood levels, and electroencephalogram (EEG) to monitor for signs of seizures. Prolonging hemodialysis in patients with signs of cefepime neurotoxicity can pose a danger for more serious sequelae, such as status epilepticus. Close monitoring of patients at high risk of developing adverse events from cefepime administration can ensure patient safety and well-being.

show abstract

Cefepime-Induced Encephalopathy: A Possible Additional Mechanism of Neurotoxicity

Cited by 2 publications

References 5 publications

Cefepime Induced Neurotoxicity Following A Regimen Dose-Adjusted for Renal Function: Case Report and Review of the Literature

Cefepime Induced Neurotoxicity Following A Regimen Dose-Adjusted for Renal Function: Case Report and Review of the Literature

Prolonged Cefepime-Induced Neurotoxicity in a Patient with End-Stage Renal Disease

Contact Info

Product

Resources

About