Abstract
Objective: To highlight the importance of recognizing Non-Convulsive Status Epilepticus (NCSE) as a serious complication in patients with encephalopathy while being treated with Cefepime.
Background: Cefepime is a 4th generation cephalosporin which is widely used to treat Gram-positive and Gram-negative bacterial infections and is frequently used during hospital admissions. Impaired renal function increases the risk for Cefepime-induced neurotoxicity and symptoms range from disorientation, aphasia, myoclonus, status epilepticus, to coma and death.
A 60-year-old female (with hypertensive emergency and respiratory failure requiring intubation) was transferred to the Neuroscience intensive care unit (NSICU) due refractory NCSE. She was being treated with Cefepime 2 gm three times a day for sepsis in a community hospital despite renal impairment. Due to persistent altered consciousness (Glasgow coma scale 6), she had undergone electroencephalographs (EEGs) which were suggestive of NCSE for which levetiracetam, lacosamide and fosphenytoin were sequentially started, however, cefepime was continued, patient was considered refractory to treatment and was transferred to our NSICU. Continuous EEG at the NSICU revealed 2–2.5 Hz generalized periodic discharges (GPDs) indicative of cefepime-induced NCSE. Cefepime was discontinued, all antiepileptics except Levetiracetam were held and continuous renal replacement therapy was initiated. Over the course of the next 6 hours, GPDs were noted to dissipate on continuous EEG and were replaced with diffuse background slowing and generalized rhythmic delta activity (GRDA). Mental status gradually improved over the next 3 days with more wakefulness and patient being able to follow simple 1-step commands crossing midline. Patient eventually was extubated and transferred to the neurology floor.
Design/Methods: Not applicable
Results: Not applicable
Conclusions: NCSEis an under-recognized complication of cefepime toxicity. Dose adjustment or avoidance of cefepime is of utmost importance when managing patients with end stagerenal disease. Early recognition is vital to improve outcome.
Disclosure: Dr. Hollen has nothing to disclose. Dr. Muzammil has nothing to disclose. Dr. Dayyoub has nothing to disclose.
Disputes & Debates: Rapid online correspondence
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