SHM Converge Scientific Abstract ePoster Gallery-Clarity and Confusion: Using Eeg in Cefepime-Induced Neurotoxicity

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This case describes a 68-year-old man with cerebral palsy, cognitive impairment, and chronic pain who was hospitalized for sepsis from a baclofen pump pocket infection. After surgical explantation of the pump, he was started on cefepime when intraoperative cultures grew Pseudomonas. By postoperative day 4, he developed worsening encephalopathy with somnolence and inability to answer questions.<br /><br />An initial evaluation for altered mental status, including laboratory tests, blood cultures, CT head, and MRI brain, was unrevealing. Although his kidney function remained normal, EEG on postoperative day 5 showed generalized seizure tendency with generalized periodic discharges and triphasic morphology, raising concern for cefepime-induced neurotoxicity (CIN). A cefepime drug level was considered but not obtained because it would not have changed management. Cefepime was stopped and switched to meropenem.<br /><br />Within a few days of discontinuing cefepime, his mental status returned to baseline. Continuous EEG also improved and was consistent with only mild generalized encephalopathy.<br /><br />The discussion emphasizes that CIN is a rare but important cause of encephalopathy, classically associated with renal impairment and elevated cefepime levels, but it can also occur in patients with normal renal function. Diagnosis is often difficult because there are no agreed-upon criteria, and EEG may provide helpful clues. Neurology consultation is encouraged when CIN is suspected.<br /><br />Management centers on stopping cefepime; hemodialysis may be considered in severe cases. Anticonvulsants are generally not recommended.

Asset Subtitle

Joshua LaBrin

Meta Tag

Author List David Chen, Joshua LaBrin

Category Clinical Vignettes

Concept Cefepime-Induced Neurotoxicity

Concept Encephalopathy

Concept Discontinuation

Concept Electroencephalography

Concept Generalized Periodic Discharges

Distinguished Non-Finalist

Presenter Organization University of Utah, Department of Internal Medicine

Presenting Author Joshua LaBrin

Track Adult

Keywords

cefepime-induced neurotoxicity

encephalopathy

Pseudomonas

baclofen pump infection

sepsis

electroencephalogram

triphasic waves

generalized periodic discharges

normal renal function

meropenem

Cefepime-Induced Neurotoxicity

Encephalopathy

Discontinuation

Electroencephalography

Generalized Periodic Discharges