Acute massive gentamicin intoxication in a patient with end-stage renal disease.
A 65-year-old man with end-stage renal disease on continuous ambulatory peritoneal dialysis accidentally received an acute massive overdose of gentamicin as a treatment of peritonitis. The patient developed acute vestibular dysfunction and hearing loss following the overdose. His serum gentamicin had reached the extremely toxic level of 220 microg/mL. To remove the gentamicin, the patient received hemodialysis and hemoperfusion immediately. This was followed by two more courses of hemodialysis during the following 2 days. The gentamicin level was brought down to 10 microg/mL after the third hemodialysis. Moderate and persistent high-frequency hearing loss was documented with serial audiograms. The patient made a gradual but incomplete recovery from the vestibular dysfunction. The complications of gentamicin toxicity and its management are discussed with respect to our patient.
Lu
C M
CM
Department of Medicine, University of Arizona Health Sciences Center, Tucson 85724, USA.
James
S H
SH
Lien
Y H
YH
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D062787:Drug Overdose; D005839:Gentamicins / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D006316:Hearing Loss, High-Frequency / Q000139:chemically induced*; D006464:Hemoperfusion; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects; D010538:Peritonitis / Q000188:drug therapy; D006435:Renal Dialysis; D015837:Vestibular Diseases / Q000139:chemically induced*
D000900:Anti-Bacterial Agents; D005839:Gentamicins