RESUMO
Acute interstitial nephritis is rarely reported with vancomycin. Literature searches revealed six biopsy-proven cases of vancomycin-induced interstitial nephritis. We report a case of a 51-year-old male who was treated with vancomycin and gentamicin for primary osteomyelitis with methicillin resistant Staphyloccocus aureus bacteremia. He developed rash and acute kidney injury after vancomycin therapy. Renal function continued to decline despite discontinuation of vancomycin and prednisone was initiated. Rapid improvement of kidney function was noted and the patient was discharged with an improved creatinine. There was a failure of compliance with steroid therapy, and a second episode of acute kidney injury developed. Creatinine again improved after restarting steroids. Physicians should consider interstitial nephritis when patients are on vancomycin even when they have been on the medication for weeks. Although there have been no controlled clinical trials on the efficacy of steroids in acute interstitial nephritis, it should still be considered if improvement is not evident after drug withdrawal.
Assuntos
Antibacterianos/efeitos adversos , Staphylococcus aureus Resistente à Meticilina , Nefrite Intersticial/diagnóstico , Osteomielite/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/efeitos adversos , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Biópsia , Gentamicinas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Nefrite Intersticial/induzido quimicamente , Nefrite Intersticial/tratamento farmacológico , Prednisona/uso terapêutico , Vancomicina/uso terapêuticoRESUMO
BACKGROUND: A 54-year-old male with a history of multiple admissions for alcohol intoxication was admitted to hospital with right flank pain. He received a high-dose lorazepam infusion for alcohol withdrawal during hospitalization and developed severe hyperosmolality, high anion gap metabolic acidosis, and acute kidney injury on his eighth day of hospitalization. INVESTIGATIONS: Serum chemistries, arterial blood gas analysis, and measurement of serum propylene glycol, ethylene glycol and methanol levels. DIAGNOSIS: Propylene glycol toxicity. MANAGEMENT: Discontinuation of lorazepam infusion, administration of fomepizole, hemodialysis for five consecutive days, hemodynamic support, and follow-up of serum osmolality as a measure of propylene glycol decay.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Delirium por Abstinência Alcoólica/tratamento farmacológico , Ansiolíticos/efeitos adversos , Lorazepam/efeitos adversos , Veículos Farmacêuticos/efeitos adversos , Propilenoglicol/efeitos adversos , Acidose/induzido quimicamente , Injúria Renal Aguda/terapia , Ansiolíticos/administração & dosagem , Composição de Medicamentos , Humanos , Infusões Intravenosas , Lorazepam/administração & dosagem , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Veículos Farmacêuticos/farmacocinética , Propilenoglicol/farmacocinética , Diálise RenalRESUMO
Propylene glycol is a commonly used solvent for oral, intravenous, and topical pharmaceutical preparations. Although it is considered safe, large intravenous doses given over a short period of time can be toxic. Underlying renal insufficiency and hepatic dysfunction raise risk for toxicity. Toxic effects include hyperosmolality, increased anion gap metabolic acidosis (due to lactic acidosis), acute kidney injury, and sepsis-like syndrome. Treatment of toxicity includes hemodialysis to effectively remove propylene glycol. Prevention is best achieved by limiting the dose of propylene glycol infused.