Hypotonia during amikacin administration in a patient treated with continuous ambulatory peritoneal dialysis

In this report we present the history of a patient treated with continuous ambulatory peritoneal dialysis (CAPD) in whom episodes of hypotonia can be related to the administration of amikacin, an antibiotic from the aminoglycosides group. The 68-year-old female patient was admitted for initiation of renal replacement therapy with CAPD. Her renal failure was probably attributable to hypertension. Three days after catheter implantation, the patient reported dysuric symptoms, and a urine culture showed significant growth of Escherichia coli. Amikacin 250 mg and cefazolin 1.0 g were administered intravenously once daily in accordance with the antibiogram. On the third day of antibiotic administration, the patient fainted, showing an arterial blood pressure of 90/60 mmHg. On the subsequent 2 days, decreases of postural arterial blood pressure to between 90/60 mmHg and 80/50 mmHg were reported two or three times daily. The patient was treated with antibiotics for the next 6 days and felt very bad the entire time, with an arterial blood pressure of 80/50 mmHg. The patient's condition improved 2 days after discontinuation of treatment with antibiotics, and episodes of hypotonia stopped. The decrease in the arterial blood pressure observed in our patient during intravenous administration of amikacin can, with a high probability, be related to the calcimimetic activity of this aminoglycoside and the resulting inhibition of parathyroid secretion.