Massive gentamicin overdose in a 14-month-old

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.