מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Cephalosporin therapy can lead to altered states of consciousness in patients with renal failure, Spanish clinicians report. Unless an electroencephalogram (EEG) is obtained, they say, the condition can be difficult to distinguish from metabolic encephalopathy.
In the August 1st issue of The American Journal of Medicine, Dr. Joan Santamaria, from the Hospital Clםnic of Barcelona in Spain, and colleagues describe 10 renal failure patients who developed nonconvulsive status epilepticus while being treated with cephalosporins.
The clinical presentation of the disorder, which began 1 to 10 days after initiating cephalosporin therapy, involved progressive disorientation or agitation, sometimes associated with mild facial, limb, or multifocal myoclonus.
The EEG pattern was similar to the "triphasic waves" seen with metabolic encephalopathy, except that the negative component of the sharp wave was greater than the amplitude of the preceding slow wave. Intravenous clonazepam completely suppressed epileptiform activity in five patients and markedly reduced it in the remainder.
After the neurologic disorder was diagnosed, cephalosporin therapy was discontinued and antiepileptic therapy was begun. All patients improved within a week of these measures being implemented.
"The cerebrospinal fluid concentration of beta-lactams is low in normal subjects due to its limited entry through the blood-brain barrier, as well as its active transport from cerebrospinal fluid to blood," the authors note. "However, in renal failure, competitive inhibition of the active transport by accumulated toxic organic acids may increase antibiotic concentrations in the cerebrospinal fluid and induce epileptogenic activity."
The current findings confirm that "cephalosporins can cause nonconvulsive status epilepticus in patients with renal failure," the researchers state. "Adjusting the cephalosporin dose for patients with impaired renal function might avoid this complication," they add.
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