title: Severe cefepime-induced status epilepticus treated with haemofiltration.
abstract: Neurotoxicity caused by cefepime may occur predominantly in patients with impaired renal function. A case of a cefepime-induced non-convulsive status epilepticus (NCSE) is presented. A 65-year-old woman suffered a severe NCSE due to cefepime in the presence of acute renal failure, requiring coma induction with sodium thiopental. A serious interaction between valproic acid (VPA) and meropenem was also produced after changing cefepime to meropenem. Continuous veno-venous haemofiltration was employed to improve cefepime clearance, and the patient progressively regained her previous mental condition. In conclusion, the cefepime dose must be adjusted according to renal function in order to avoid toxicity in patients with renal failure. Electroencephalogram should be considered in cases of acute confusional state in patients receiving cefepime, to achieve early detection of NCSE. Continuous renal replacement therapy may be successfully employed in severe cases in order to accelerate cefepime removal. Likewise, meropenem should not be used concomitantly with VPA.
authors.affiliation: Department of Anaesthesiology and Critical Care, Hospital Universitario La Paz, Madrid, Spain. Electronic address: alejandro.suarez.delarica@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Suarez-de-la-Rica
authors.affiliation: Department of Anaesthesiology and Critical Care, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Hernández-Gancedo
authors.affiliation: Department of Anaesthesiology and Critical Care, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: López-Tofiño
authors.affiliation: Department of Anaesthesiology and Critical Care, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Maseda
authors.affiliation: Department of Anaesthesiology and Critical Care, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Gilsanz
mesh_terms: D058186:Acute Kidney Injury; D000368:Aged; D004569:Electroencephalography / Q000009:adverse effects; D005260:Female; D006440:Hemofiltration / Q000009:adverse effects; D006801:Humans; D013226:Status Epilepticus / Q000139:chemically induced*
keywords: Adverse event; Antibiotics; Antibióticos; Cefepime; Efecto secundario; Estatus epiléptico; Haemofiltration; Hemofiltración; Status epilepticus