SHM Converge Scientific Abstract ePoster Gallery-It's Always the Med List: A Hidden Cause of Asterixis

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This case describes a 76-year-old man with prostate cancer, hypertension, diabetes, chronic kidney disease, and COPD who presented after dizziness and near-fall following a day of vomiting and poor oral intake. He also developed shaking movements of the arms, head, and torso. Exam showed marked asterixis and rhythmic jerking. Initial workup found acute kidney injury and hypercapnia, but no evidence of liver disease, electrolyte abnormality, intracranial lesion, or chronic respiratory acidosis.<br /><br />Further history revealed that he had taken 1800 mg of gabapentin the day before admission for chronic back pain. Gabapentin was stopped, and his asterixis resolved spontaneously over the next few days, along with normalization of blood gas abnormalities. The authors concluded that vomiting likely caused AKI, reducing gabapentin clearance and leading to drug accumulation and neurotoxicity.<br /><br />The report emphasizes that gabapentin, though commonly perceived as relatively benign, can cause toxicity in high-risk patients—especially older adults, those with kidney disease, and patients with COPD. Toxicity may present with dizziness, ataxia, somnolence, respiratory depression, or asterixis. The case highlights the importance of careful medication review when new asterixis occurs and counseling patients to temporarily hold gabapentin during episodes of vomiting, poor intake, or other situations that may trigger AKI.

Asset Subtitle

Youssef Saklawi

Meta Tag

Author List Nikita Deng, Youssef Saklawi

Category Clinical Vignettes

Concept Gabapentin Toxicity

Concept Asterixis

Concept Myoclonus

Concept Chronic Kidney Disease

Concept Acute Kidney Injury

Distinguished Non-Finalist

Presenter Organization Emory Division of Hospital Medicine

Presenting Author Youssef Saklawi

Track Adult

Keywords

gabapentin toxicity

asterixis

acute kidney injury

hypercapnia

chronic kidney disease

COPD

vomiting

neurotoxicity

older adults

medication review

Gabapentin Toxicity

Asterixis

Myoclonus

Chronic Kidney Disease

Acute Kidney Injury