title: Convulsions in a critically ill patient on hemodialysis: Possible role of low dose colistin.
abstract: The increasing prevalence of multi-drug resistant Gram-negative pathogens in intensive care units has led to the revival of colistin. Colistin had gone into disrepute in early 1970s because of numerous reports of adverse renal and neurological effects. The renewed interest in colistin has also revived the discussion about its toxicity. The neurotoxicity reported in literature is usually with higher doses of colistin. We present a case report of seizures in a critically ill-patient, possibly with low dose colistin. A 47-year-old hypertensive female with chronic kidney disease-5 with sepsis on colistimethate sodium 1 million units (80 mg), intravenous once daily, developed paresthesias and seizures on 12(th) day of therapy, which were subsequently controlled after withdrawl of the drug. To conclude, colistin should be considered as a cause of convulsions in critically ill-patients with renal failure, even when given in low dose and patient receiving intermittent hemodialysis, when other obvious causes have been ruled out. When possible, cessation of therapy may be considered.
authors.affiliation: Department of Critical Care, SPS Apollo Hospitals, Ludhiana, Punjab, India.
authors.forename: Kanwalpreet
authors.initials: K
authors.lastname: Sodhi
authors.affiliation: Department of Nephrology, SPS Apollo Hospitals, Ludhiana, Punjab, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kohli
authors.affiliation: Department of Critical Care, SPS Apollo Hospitals, Ludhiana, Punjab, India.
authors.forename: Basjinder
authors.initials: B
authors.lastname: Kaur
authors.affiliation: Department of Neurosciences, SPS Apollo Hospitals, Ludhiana, Punjab, India.
authors.forename: Sidhartha
authors.initials: S
authors.lastname: Garg
authors.affiliation: Department of Anaesthesia and Critical Care, SPS Apollo Hospitals, Ludhiana, Punjab, India.
authors.forename: Anupam
authors.initials: A
authors.lastname: Shrivastava
authors.affiliation: Department of Anaesthesia and Critical Care, SPS Apollo Hospitals, Ludhiana, Punjab, India.
authors.forename: Manender
authors.initials: M
authors.lastname: Kumar
keywords: Colistin; critically ill; intensive care unit; neurotoxicity; renal failure; seizures