Acute respiratory muscle weakness and apnea in a critically ill patient induced by colistin neurotoxicity: key potential role of hemoadsorption elimination during continuous venovenous hemofiltration

Abstract

Patrick M Honore,1 Rita Jacobs,1 Stijn Lochy,1 Elisabeth De Waele,1 Viola Van Gorp,1 Jouke De Regt,1 Geert Martens,1 Olivier Joannes-Boyau,2 Willem Boer,3 Herbert D Spapen1 1Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; 2Haut Leveque University Hospital of Bordeaux, University of Bordeaux 2, Pessac, France; 3Ziekenhuis Oost-Limburg, Genk, Belgium Abstract: We describe a patient with severe New Delhi metallo-β-lactamase-1 Escherichia coli infection who developed convulsions rapidly followed by acute respiratory muscle weakness and apnea while receiving intravenous colistin. Toxic levels of colistin were rapidly removed by hemofiltration and, more specifically, by hemoadsorption. Keywords: colistin, neurotoxicity, convulsions, neuromuscular blockade, apnea, hemofiltration, hemoadsorption, CVVH, CRRT