Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
A 55-year-old male with diabetes and chronic renal failure develops an abdominal abscess that requires surgical intervention. A laparotomy is performed, and the abscess is drained. Post-operatively, the patient is placed on imipenem/cilastin. Imipenem places the patient at an increased risk of developing which of the following?
A.Seizures
B.Rhabdomyolysis
C.Tumor lysis syndrome
D.Kernicterus
E.Hypokalemia
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
imipenem and Meropenem
ADR: Seizures.
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
Choice (A) is the correct answer. Imipenem is a carbapenem, beta-lactamase resistant antibiotic with broad spectrum coverage. It covers many gram positive organisms, anaerobes, and gram negative rods, including pseudomonas. Imipenem is inactivated in the proximal renal tubules by the enzyme dihydropeptidase I. Imipenem is administered with cilastin which acts to inhibit dihydropeptidase I. At high plasma levels, seizures can occur with imipenem, particularly in patients with renal failure. Rhabdomyolysis (Choice B) occurs as a result of muscle tissue breakdown that results in an elevated creatine kinase level. A urinalysis shows large blood, though no red blood cells can be seen on microscopic analysis. This is because myoglobin cross-reacts with the urinalysis assay. Rhabdomyolysis can precipitate renal failure. Tumor lysis syndrome (Choice C) is a serious, potentially life-threatening complication of chemotherapy treatment. When tumor cells are killed, they release their contents which can result in hyperkalemia, hyperphosphatemia with secondary hypocalcemia, and elevated levels of uric acid that can precipitate renal failure. Allopurinol is given before chemotherapy to prevent the formation of uric acid. Vigorous hydration is also paramount. Sulfonamide drugs are contraindicated in infancy because of the increased risk of kernicterus (Choice D) caused by hyperbilirubinemia. (Choice E) is incorrect.
