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Carbapenem Neurotoxicity ESKD — ESENeph MCQ

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HardHaemodialysisCarbapenem Neurotoxicity ESKDESENeph

A 55-year-old man with ESKD on haemodialysis develops a seizure. He was recently prescribed Meropenem for a serious infection. His pre-dialysis blood sample shows no electrolyte disturbance. What is the most likely cause?

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Correct answer: B — Meropenem accumulation causing neurotoxicity – carbapenem dose must be reduced in ESKD

Carbapenems (Meropenem, Imipenem, Ertapenem) are renally cleared and require dose reduction in CKD/ESKD. Accumulation causes neurotoxicity manifesting as seizures, myoclonus, and confusion. Meropenem is the least epileptogenic carbapenem but still requires dose adjustment (typically 500 mg-1 g 12-hourly for HD patients, with supplemental dosing post-dialysis). Imipenem has the highest seizure risk among carbapenems. Checking the prescribed dose against renal dosing guidelines is essential.

Reference: BNF 2024 – Meropenem Renal Dosing; KDIGO 2012 – AKI (Drug Dosing)