title: Lesson of the month 2: An easily missed cause of confusion.
abstract: We describe the case of an 85-year-old woman who developed acute confusion, acute kidney injury and temperature spikes while on extended courses of beta-lactams for osteomyelitis. The cause of her deterioration was felt to be due to sepsis when in fact it was as a result of toxicity from antibiotics. This was demonstrated by a rapid resolution in her condition following haemodialysis. We also performed a literature review to appraise the neuro and nephrotoxicity of various antibiotics and how best to manage toxicity when it occurs.
authors.affiliation: Royal Free Hospital, London, UK benoliveira@nhs.net.
authors.forename: Ben
authors.initials: B
authors.lastname: Oliveira
authors.affiliation: Royal Free Hospital, London, UK.
authors.forename: Sangita
authors.initials: S
authors.lastname: Chaterjee
authors.affiliation: Royal Free Hospital, London, UK.
authors.forename: Aine
authors.initials: A
authors.lastname: Burns
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003221:Confusion / Q000139:chemically induced*; D003937:Diagnosis, Differential; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005334:Fever / Q000139:chemically induced; D006801:Humans; D010019:Osteomyelitis / Q000188:drug therapy; D047090:beta-Lactams / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams
keywords: AKI; Acute kidney injury; beta-lactams; dialysis; encephalopathy; toxicity