Renal failure status epilepticus

Possible risk factors include trauma, unusual physical exercise, surgery, severe systemic illness, severe dieting, dietary excess, alcohol, drugs, status epilepticus, psoriasis, renal failure, lead intoxication, Down s syndrome, high purine diet, cytolytic therapy, myeloproliferative and lymphoproliferative disorders. Mr KT has several risk factors which increase his chances of developing gout ... 

Five patients developed severe symptoms after receiving cefepime (31). The patients, three men and two women, aged 16-75 years, received 2 g/day (n — 3) A g/day n = 1) or 9 g/day n — 1). The symptoms started 12-16 days after the start of therapy. In all cases, the initial neurological symptoms (disorientation, confusion, and reduced consciousness) were progressive and were attributed to the infection. Facial or multifocal myoclonic movements occurred subsequently and were rapidly followed by convulsive or non-convulsive status epilepticus. The dose of cefipime had not been adjusted for renal function in any of the patients. Cefepime serum concentrations were measured in three cases, and were 72, 73, and 134 gg/ml. All the patients underwent hemodialysis, and the serum concentrations of cefepime fell to 4.3, 21, and 25 gg/ml respectively. In the other two patients, the serum concentrations after dialysis were 14 and 54 gg/ml, suggesting high concentrations before dialysis. There was complete recovery in four of the patients. One, a 73-year-old woman, died of multiorgan failure with refractory status epilepticus and coma. The authors referred to four... 

Wang JL, Cheng CH, Wu MJ, Chen CH, D, Shu KH. (In Chinese) Status epilepticus in two patients with chronic renal failure after ingestion of star fruit. Kidney Dialysis 2000 8 166-169. 

Rhabdomyolysis—The breakdown of muscle tissue and release of myoglobin and intracellular electrolytes into the circulation due to a variety of causes such as crush injuries, drug-induced immobilization, and status epilepticus. It often leads to acute renal failure. 

C. Death may be caused by ventricular arrhythmia, status epilepticus, intracranial hemorrhage, or hyperthermia. Hyperthermia frequently results from seizures and muscular hyperactivity and may cause brain damage, rhab-domyolysis, and myoglobinuric renal failure (see p 21). 

Drug-device interactions In a 59-year-old man with refractory status epilepticus taking topiramate, clinically important amounts of topiramate were removed by continuous venovenous hemodiafiltration for acute renal failure [302" ]. Higher doses of topiramate should therefore be used during this procedure. 

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