Methylprednisolone sodium succinate/polymyxin B/sufentanil
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Methylprednisolone sodium succinate/polymyxin B/sufentanil Worsening renal function and neurotoxicity in the form of decreased muscle strength and cognitive impairment: 5 case reports
In a retrospective analysis of 6 patients treated for renal impairment in an ICU between February 2018 and May 2019, 5 patients (3 men and 2 women) aged 28–67 years were described, who experienced worsening renal function following off-label therapy with polymyxin B. One of these patients additionally developed neurotoxicity in the form of decreased muscle strength and cognitive impairment secondary to polymyxin B, and the administration of methylprednisolone sodium succinate and sufentanil was thought to have contributed to the same. The patients, who had acute renal failure secondary to infection (n=4) and stage V chronic kidney disease (n=1), started receiving off-label therapy with polymyxin B 50mg every 12 hours (i.e. 100 mg/day) through an IV drip. However, all patients subsequently exhibited decrease in creatinine clearance, which was attributed to the treatment with polymyxin B. One patient, who had fulminant myocarditis, received polymyxin B from 3 May 2019 to 12 May 2019; however, on 5 May 2019, she exhibited a grade III decrease in lower extremity muscle strength, which decreased to grade II on 10 May 2019, and to grade I on 13 May 2019, while the upper extremity muscle strength decreased to grade IV. Additionally, on 13 May 2019, she experienced transient cognitive impairment. She could not recall her name or her marital status; however, her cognition spontaneously returned to baseline later that day. She underwent electromyogram (EMG) examination on the same day; motor nerve conduction studies revealed a decrease in the compound muscle action potential amplitude of the left and right common peroneal nerves. Sensory nerve conduction studies showed normal results, while the F-wave study demonstrated that the occurrence rate and latency of F-waves in the left median nerve and left and right posterior tibial nerves were normal. The EMG results revealed the presence of spontaneous potentials in the right and left tibialis anterior muscles, right extensor digitorum brevis muscle, right and left biceps femoris muscles and right L4 paraspinal muscle, and their inability to contract. The right and left gastrocnemius muscles, right peroneus longus muscle and right vastus medialis muscle did not exhibit spontaneous potentials and were unable to contract. The EMG findings concluded that she had neurogenic damage involving both lower extremities. Of note, she had also received injections of sufentanil [sufentanil citrate] 300 mg/day through an IV pump from 1 May 2019 to 5 May 2019, as well as injections of methylprednisolone sodium succinate 80 mg/day through an IV drip from 2 May 2019 to 5 May 2019, which were thought to increase the risk for neurotoxicity due to polymyxin B [not all times to reactions onsets clearly stated]. All patients received supportive treatment for worsening renal function in the form of continuous renal
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