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Here, we report a rare toxicity by gabapentin overdose: rhabdomyolysis and acute renal failure. To date, only five cases reported gabapentin-induced rhabdomyolysis in PubMed database. The newer anticonvulsant agents include: Gabapentin, Lamotrigine, Levetiracetam, Oxcarbazepine, Pregabalin, Tiagabine, Topiramate and Vigabatrin. These are generally less toxic in overdose causing sedation and non-specific neurological symptoms and patients do well with supportive care. Toxic Mechanism: Gabapentin toxicity should be considered one of the differential diagnoses of altered consciousness in patients with compromised renal function, even after a single dose. We report a 57-year-old woman with diabetes mellitus and uraemia on regular ported with hemodialysis. The workgroup assessed gabapentin and pregabalin as “dialyzable” for patients with decreased kidney function (quality of the evidence grade as A and B, respectively). Limited clinical data were available (24 patients with gabapentin toxicity and 7 with pregabalin toxicity received ECTR). Acute oral overdoses of gabapentin have been reported. Symptoms have included double vision, tremor, slurred speech, drowsiness, altered mental status, dizziness, lethargy, and diarrhea. Fatal respiratory depression has been reported with gabapentin overdose, alone and in combination with other CNS depressants. Background Gabapentin, a structural analog of γ-aminobutyric acid, although developed for epilepsy, is often used for pain, insomnia and anxiety. It is considered very safe, with neurotoxicity mostly limited to renally-impaired patients. Design/Methods: Case Report. We describe a patient who developed significant deterioration in her conscious level due to iatrogenic gabapentin overdose. Conclusion: All doctors need to be aware of the need to review the indications for gabapentin use during periods of acute illness, especially with regard to renal impairment. Off-label use should be discouraged. We describe a patient who developed significant deterioration in her conscious level due to iatrogenic gabapentin overdose. Conclusion. All doctors need to be aware of the need to review the indications for gabapentin use during periods of acute illness, especially with regard to renal impairment. Since gabapentin is cleared solely by renal excretion, dosing requires consideration of the patient's renal function. Myoclonic activity may occur as a complication of gabapentin toxicity, especially with acute kidney injury or end-stage renal disease. Acute drug toxicity was deemed the underlying cause of death in most cases (92.8% of gabapentin cases [n = 847/913]; 95.1% of pregabalin cases [n = 2209/2322]), with the detected gabapentinoid implicated in causing death in approximately half of cases (49.2% of gabapentin cases [n = 449/913]; 54.9% of pregabalin cases [n = 1274/2322]). Gabapentinoids are commonly ingested in self-harm attempts and often misused for their sedative and euphoric properties. These medications can cause lethargy or agitation in overdose, increase risk of death combined with opioids, and manifest a withdrawal syndrome. “Gabapentin,” U.S. National Library of Medicine, 2022. “ Suicide by gabapentin overdose,” National Center for Biotechnology Information (NCBI), 2011. “ An acute gabapentin fatality: a case report with postmortem concentrations,” National Center for Biotechnology Information (NCBI), 2015. Gabapentin toxicity should be considered one of the differential diagnoses of altered consciousness in patients with compromised renal function even after a single dose. We recommend holding gabapentin while acute illness or dehydration is present, unless used as AED, in which case renal function should be monitored closely. 3. Symptomatic gabapentin toxicity in patients with acute kidney injury requires consultation with a neurologist and nephrologist for appropriate management. In a retrospective, non-interventional cross-sectional review of exposures reported to one regional poison control center was performed from 01 January 2012 to 31 December 2015, three patients were described, a 51-year-old man died due to gabapentin overdose, a 42-year-old woman developed bradycardia, autonomic instability, acute renal failure, metabolic acidosis and anoxic brain injury Myoclonic activity may occur as a complication of gabapentin toxicity, especially with acute kidney injury or end-stage renal disease. We report 2 cases of myoclonic activity associated with gabapentin toxicity in the setting of renal disease which resolved with discontinuation of gabapentin and treatment with hemodialysis and peritoneal dialysis. Gabapentin is a unique anticonvulsant that is used as adjunctive therapy in management of epilepsy and for neuropathic pain syndromes. Therapy with gabapentin is not associated with serum aminotransferase elevations, but several cases of clinically apparent liver injury from gabapentin have been reported. Gabapentin is an anticonvulsive medication that received approval from the US Food and Drug Administration (FDA) in 1993 and has been available in generic form in the USA since 2004. Gabapentin was originally used as a muscle relaxant and an anti-spasmodic. However, it was later discovered that gaba Gabapentin was discontinued due to concern for acute toxicity, and blood testing confirmed toxic range level (42 μg/mL, therapeutic range 2–20 μg/mL). Results: Patient was initiated on intermittent hemodialysis with complete recovery in mental and respiratory status on day 3. The patient was advised that his acute liver injury could be secondary to gabapentin, and he was instructed to discontinue taking gabapentin. At the outpatient follow-up with gastroenterology eight weeks later, the patient had a repeat testing of his transaminase levels, whose results were normal (Table 1 ).
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