Management of amikacin overdose

Area of Science:

• Pharmacology
• Nephrology
• Critical Care Medicine

Background:

• Subarachnoid hemorrhage management sometimes involves aminoglycoside antibiotics like amikacin.
• Accidental administration of a 20-fold overdose of amikacin occurred in a patient with subarachnoid hemorrhage.

Observation:

• The patient received 18 g of amikacin over 4 hours, a dose significantly exceeding the recommended daily limit.
• Management included aggressive intravenous fluid administration and peritoneal dialysis to enhance amikacin elimination.
• Sequential drug level monitoring was performed in serum, urine, and peritoneal dialysate.

Findings:

• Renal clearance of amikacin was significantly increased compared to standard dosing.
• Amikacin was rapidly excreted via the kidneys, with no detectable levels in the peritoneal dialysate.
• The patient experienced no apparent toxic effects despite the substantial overdose.

Implications:

• Aggressive hydration and forced diuresis are effective strategies for managing amikacin overdose in patients with normal renal function.
• Peritoneal dialysis may not be a primary method for amikacin elimination in such cases.
• This case supports the safety and efficacy of supportive care in mitigating amikacin toxicity.