title: Cloxacillin-induced seizure in a hemodialysis patient.
abstract: We are reporting a cloxacillin-induced seizure in a patient with stage 5 chronic kidney disease requiring hemodialysis. To our knowledge, there are no published case reports of seizures induced by parenteral cloxacillin in hemodialysis patients. A young hemodialysis female was admitted to the hospital with decreased level of consciousness. Blood cultures revealed methicillin-sensitive Staphylococcus aureus where cloxacillin 2 g intravenously every 4 hours was initiated. Head computed tomography (CT) was not significant. After 14 hours of cloxacillin therapy (4 doses), the patient demonstrated tonic/clonic seizure activity, where phenytoin and lorazepam were initiated. The anti-seizure medications partially reduced seizure activity. Once the cloxacillin was discontinued, the seizures stopped. Two weeks later, all anti-seizure medications were stopped with no further seizure activity. Cloxacillin elimination in hemodialysis patients is similar to patients with normal kidney function. Although cloxacillin does not significantly cross the blood-brain barrier, the correlation between the start of seizures and cloxacillin initiation was confirmed by the negative CT and blood chemistry laboratory results. Moreover, seizure activity was terminated upon discontinuation of cloxacillin. Although further investigation for the cause of such seizures is warranted, clinicians should use caution when giving high doses of cloxacillin in hemodialysis patients.
authors.affiliation: Department of Nephrology, Windsor Regional Hospital, Windsor, Ontario, Canada.|Department of Pharmacy, Windsor Regional Hospital, Windsor, Ontario, Canada.
authors.forename: Wasim
authors.initials: W
authors.lastname: El Nekidy
authors.affiliation: Department of Nephrology, Windsor Regional Hospital, Windsor, Ontario, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Dziamarski
authors.affiliation: Department of Nephrology, Windsor Regional Hospital, Windsor, Ontario, Canada.|Department of Pharmacy, Windsor Regional Hospital, Windsor, Ontario, Canada.
authors.forename: Derrick
authors.initials: D
authors.lastname: Soong
authors.affiliation: Department of Pharmacy, Windsor Regional Hospital, Windsor, Ontario, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Donaldson
authors.affiliation: Department of Nephrology, Windsor Regional Hospital, Windsor, Ontario, Canada.
authors.forename: Muhieldean
authors.initials: M
authors.lastname: Ibrahim
authors.affiliation: Department of Nephrology, Windsor Regional Hospital, Windsor, Ontario, Canada.
authors.forename: Albert
authors.initials: A
authors.lastname: Kadri
mesh_terms: D003023:Cloxacillin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000188:drug therapy; D012640:Seizures / Q000139:chemically induced*; D013203:Staphylococcal Infections / Q000188:drug therapy*
chemical_list: D003023:Cloxacillin
keywords: Cloxacillin; hemodialysis; seizures