Cefepime-Induced脑病在高危患者肾功能不全和肝硬化。

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奥尔特加AJ, Ghafouri SR, Vu L,爱德华兹B,镍N

Cefepime-Induced脑病在高危患者肾功能不全和肝硬化。

Cureus。2021年10月14日,13 (10):e18767。doi: 10.7759 / cureus.18767。eCollection 2021年10月。

PubMed ID

34796060 (在PubMed

]

文摘

第四代头孢吡肟,头孢菌素抗生素常用的一线经验治疗各种细菌感染。它主要是分泌肾;因此,减少肾脏功能允许头孢吡肟的积累有潜在毒性水平。这里我们提出一个案件cefepime-induced脑病(CIE)的67岁男性病人在晚期肾功能不全和肝硬化是承认我们医院改变精神状态(AMS)。病人最初治疗肝性脑病(他)氨水平升高(105 microg / dL),显著提高。他也被放置在静脉注射(IV)头孢吡肟对假单胞菌菌血症。四天后,病人和困惑变得昏昏欲睡。详细检查对于AMS的次要原因进行然而未发现明显的异常严重。氨水平保持在正常范围内。没有急性颅内病理报道头部电脑断层扫描(CT)。 Furthermore, an electroencephalograph (EEG) was obtained which showed generalized periodic discharge with a tri-phasic wave pattern suggesting non-convulsive status epilepticus (NCSE). CIE was suspected at that point and cefepime administration was stopped. Following cefepime discontinuation, there was a remarkable improvement in the patient's mental status for several days after cefepime discontinuation that supported the diagnosis of CIE in our patient. Although the exact pathophysiology is unclear, CIE should be suspected in elderly patients, patients with renal dysfunction, and critical illness. Meanwhile, liver dysfunction can be an additional risk factor for CIE as it increases the permeability of the blood-brain barrier (BBB), altered neurotransmission, and neuro-inflammation.

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头孢吡肟