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Why can cefepime cause neurological toxicity?
And why is renal failure the main risk factor for this complication?
The answer requires us to learn about cefepime's structure and why it unexpectedly binds to a certain CNS receptor.
#MedTwitter #Tweetorial
2/
Let's establish a few facts about cefepime:
🔺4th generation cephalosporin antibiotic
🔺Excretion = exclusively in the urine (mostly as unchanged drug)
🔺Readily crosses the blood-brain barrier (so it easily accesses the brain)
https://t.co/rjYG1BfGPR
3/
The first report of cefepime neurotoxicity was in 1999.
A patient w/ renal failure received high doses of cefepime and then developed encephalopathy, tremors, myoclonic jerks, and tonic-clonic seizures.
✅All symptoms resolved after hemodialysis.
https://t.co/u7JLVitQpp
4/
Cefepime neurotoxicity is surprisingly common, occurring in up to 15% of treated critically ill patients (w/ symptoms varying from encephalopathy to seizures).
💡The main risk factors = renal failure and lack of dose adjustment for renal function.
https://t.co/nxbnzSq8AR
5/
What about cefepime induces neurotoxicity?
One clue is that it's not the only antibiotic that causes neurotoxicity, particularly seizures.
This actually is a class effect w/ other beta-lactam antibiotics (including penicillins and carbapenems).
https://t.co/Lf4BhON9IY
Why can cefepime cause neurological toxicity?
And why is renal failure the main risk factor for this complication?
The answer requires us to learn about cefepime's structure and why it unexpectedly binds to a certain CNS receptor.
#MedTwitter #Tweetorial

2/
Let's establish a few facts about cefepime:
🔺4th generation cephalosporin antibiotic
🔺Excretion = exclusively in the urine (mostly as unchanged drug)
🔺Readily crosses the blood-brain barrier (so it easily accesses the brain)
https://t.co/rjYG1BfGPR

3/
The first report of cefepime neurotoxicity was in 1999.
A patient w/ renal failure received high doses of cefepime and then developed encephalopathy, tremors, myoclonic jerks, and tonic-clonic seizures.
✅All symptoms resolved after hemodialysis.
https://t.co/u7JLVitQpp

4/
Cefepime neurotoxicity is surprisingly common, occurring in up to 15% of treated critically ill patients (w/ symptoms varying from encephalopathy to seizures).
💡The main risk factors = renal failure and lack of dose adjustment for renal function.
https://t.co/nxbnzSq8AR

5/
What about cefepime induces neurotoxicity?
One clue is that it's not the only antibiotic that causes neurotoxicity, particularly seizures.
This actually is a class effect w/ other beta-lactam antibiotics (including penicillins and carbapenems).
https://t.co/Lf4BhON9IY

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Trump is gonna let the Mueller investigation end all on it's own. It's obvious. All the hysteria of the past 2 weeks about his supposed impending firing of Mueller was a distraction. He was never going to fire Mueller and he's not going to
Mueller's officially end his investigation all on his own and he's gonna say he found no evidence of Trump campaign/Russian collusion during the 2016 election.
Democrats & DNC Media are going to LITERALLY have nothing coherent to say in response to that.
Mueller's team was 100% partisan.
That's why it's brilliant. NOBODY will be able to claim this team of partisan Democrats didn't go the EXTRA 20 MILES looking for ANY evidence they could find of Trump campaign/Russian collusion during the 2016 election
They looked high.
They looked low.
They looked underneath every rock, behind every tree, into every bush.
And they found...NOTHING.
Those saying Mueller will file obstruction charges against Trump: laughable.
What documents did Trump tell the Mueller team it couldn't have? What witnesses were withheld and never interviewed?
THERE WEREN'T ANY.
Mueller got full 100% cooperation as the record will show.
BREAKING: President Donald Trump has submitted his answers to questions from special counsel Robert Mueller
— Ryan Saavedra (@RealSaavedra) November 20, 2018
Mueller's officially end his investigation all on his own and he's gonna say he found no evidence of Trump campaign/Russian collusion during the 2016 election.
Democrats & DNC Media are going to LITERALLY have nothing coherent to say in response to that.
Mueller's team was 100% partisan.
That's why it's brilliant. NOBODY will be able to claim this team of partisan Democrats didn't go the EXTRA 20 MILES looking for ANY evidence they could find of Trump campaign/Russian collusion during the 2016 election
They looked high.
They looked low.
They looked underneath every rock, behind every tree, into every bush.
And they found...NOTHING.
Those saying Mueller will file obstruction charges against Trump: laughable.
What documents did Trump tell the Mueller team it couldn't have? What witnesses were withheld and never interviewed?
THERE WEREN'T ANY.
Mueller got full 100% cooperation as the record will show.