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Massive gentamicin overdose in a 14-month-old
Scott J Schurman1, Vickie Keeler, Thomas R Welch
1Department of Pediatrics, State University of New York, Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA. schurmas@upstate.edu
Pediatric Nephrology (Berlin, Germany)
|August 13, 2008
Summary
A child experienced a gentamicin overdose but recovered fully after prompt hemodialysis. This case highlights hemodialysis as an effective treatment for high gentamicin levels, preserving renal and auditory function.
Area of Science:
- Pediatric Nephrology
- Clinical Pharmacology
- Toxicology
Background:
- Gentamicin is a critical antibiotic for severe infections but carries risks of nephrotoxicity and ototoxicity.
- Accidental overdoses can lead to dangerously high serum concentrations.
- Monitoring and timely intervention are crucial for managing gentamicin toxicity.
Observation:
- A 14-month-old girl received a significant gentamicin overdose (56 mg/kg).
- Despite normal baseline renal function, serum gentamicin levels reached 89 mg/L.
- The patient presented with a unique case of extremely high gentamicin levels in a healthy child.
Findings:
- Prompt hemodialysis initiated 4 hours post-administration effectively reduced serum gentamicin levels from 89 mg/L to 3.4 mg/L within 4 hours.
- Post-hemodialysis gentamicin levels continued to decline, reaching 2.3 mg/L four hours after treatment cessation.
- Three months later, the child exhibited normal renal function (serum creatinine 0.3 mg/dl) and normal hearing bilaterally.
Implications:
- This case demonstrates the efficacy of hemodialysis in rapidly clearing gentamicin, even at extremely high concentrations in patients with normal renal function.
- Early intervention with hemodialysis may prevent potential long-term adverse effects on renal and auditory health.
- Highlights the importance of vigilant monitoring and prompt management strategies for aminoglycoside overdoses.
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