Non-convulsive status epilepticus possibly induced by a rapid correction of severe hyperkalemia: a case report and literature review

Bussaka, Saki; Suehiro, Takaichi; Mitsuiki, Koji; Morioka, Takato; Shono, Tadahisa; Fujiki, Fujio; Nakano, Toshiaki

doi:10.1186/s12882-023-03141-1

Table 2 Summary of reported cases with nonconvulsive status epilepticus with renal dysfunction and cefepime

From: Non-convulsive status epilepticus possibly induced by a rapid correction of severe hyperkalemia: a case report and literature review

Patient no	Age / gender	Diagnoses	Creatinine (mg/dL)	Renal function	Dialysis mode	Clinical signs	Treatment	Outcome	Author	Reference
1	61/F	Febrile neutropenia, multiple myeloma	8.0	CKD	HD	Contractions of eyelids, chin, hands, and arms	Diazepam, clonazepam	Improved clinical symptoms	Ozturk	[17]
2	72/M	Central line sepsis, hepatitis B, diabetes mellitus, hypertension, seizure disorder, moderate obesity	6.8	CKD	HD	Confusion	Diazepam	Condition recovered gradually; EEG study showed no abnormal discharges	Iftikhar	[2]
3	44/M	Pneumonia, bilateral orthotopic lung transplant	5.8	CKD	HD	Confusion, obtundation, clonus	Lorazepam, valproic acid	Rapid recovery in mental status, absent epileptiform discharges in EEG, although showed mild slowing of the background	Dixit	[23]
4	52/M	Urinary tract infection, hypertension, diabetes mellitus	3.4	CKD	HD	Delirium, disorientation, agitation, myoclonic jerks	Diazepam	Clinical symptoms and EEG findings improved	Bora	[19]
5	68/F	Pneumonia, diabetes mellitus	NR	CKD	HD	Confusion, stupor, lip smacking	Valproic acid, lorazepam	EEG findings and her mental state improved gradually	Lee	[3]
6	29/M	Brain abscess	2.4	CKD	HD	Stupor	Diazepam, phenytoin	NR	Ozturk	[17]
7	NR	NR	NR	CKD	HD	Confusion with global aphasia	Discontinue of cefepime	Neurologic and electroencephalographic status normalized in a few days	Barbey	[37]
8	69/F	Pneumonia	14.2	CKD	PD	Confusion	Diazepam, phenytoin	EEG improvement followed by mental recovery	Chow	[1]
9	48/F	Amyloidosis susp, bronchiectasis	7.5	CKD	PD	Agitation, speech difficulty, hand tremor, loss of consciousness	Diazepam	Consciousness improved	Ozturk	[17]
10	48/F	Acute bronchitis, hypertension	5.2	CKD	PD, temporary HD	Confusion	Diazepam, phenytoin	Made a good recovery	Iftikhar	[2]
11	49/F	Kidney transplant, acute pyelonephritis	CCr 39 ml/min	CKD	-	Stupor	Lorazepam, levetiracetam	Epileptiform activities ceased and regained her baseline mental status	Balderia	[38]
12	39/F	Septic arthritis, ankylosing spondylitis, amyloidosis	6.5	CKD	-	Agitation, confusion, myoclonic jerks	Diazepam	Clinical symptoms and EEG findings improved	Bora	[19]
13	83/F	Pneumonia, lung tuberculosis, chronic atrial fibrillation	6.1	CKD	-	Stupor	Diazepam, phenytoin	Consciousness improved completely	Ozturk	[17]
14	33/F	Febrile neutropenia, cellulitis, chronic allograft nephropathy, diabetes mellitus	6.0	CKD	-	Disorientation, loss of consciousness	Diazepam, phenytoin	Improved clinical symptoms	Ozturk	[17]
15	86/M	Osteomyelitis	5.1	CKD	-	Agitation, confusion, myoclonus	Valproate, phenytoin	Improvement of clinical symptoms	Martinez-Rodriguez	[15]
16	64/F	Pneumonia	5.0	CKD	-	Agitation, confusion, myoclonus	Clonazepam, phenytoin	Clinical improvement immediately	Martinez-Rodriguez	[15]
17	58/F	Bronchopneumonia, mesothelioma, diabetes mellitus, coronary artery disease	4.7	CKD	-	Less responsive, unable to speak	Diazepam	Clinical and neurophysiological findings began to normalize	Bora	[19]
18	79/M	Pneumonia	4.5	CKD	-	Confusion, myoclonus	Clonazepam, valproate	Improvement of clinical symptoms	Martinez-Rodriguez	[15]
19	68/M	Pneumonia, osteomyelitis, prostate cancer, bone metastases	4.0	CKD	-	Confusion, disorientation	Diazepam	Remission of neuropsychological and clinical findings	Bora	[19]
20	67/F	Pneumonia	3.5	CKD	-	Drowsiness, confusion	Clonazepam	Clinical improvement immediately	Martinez-Rodriguez	[15]
21	54/M	Liver cirrhosis, prophylaxis	3.2	CKD	-	Agitation, confusion	Clonazepam, diazepam	Improvement of clinical symptoms	Martinez-Rodriguez	[15]
22	70/F	Febrile neutropenia, non-Hodgkin’s lymphoma, hypertension, seizure disorder,	2.8	CKD	-	Agitation, myoclonus	Levetiracetam, phenytoin	Returned to baseline mental function	Gangireddy	[24]
23	86/M	Right lower lobe pneumonia	2.5	CKD	-	Agitation, confusion	Lorazepam, phenytoin	EEG showed resolution of the epileptiform activity, remained alert and conscious	Chang	[20]
24	58/F	Urinary infection, acute rejection, pyelonephritis, transplanted kidney	2.0	CKD	-	Impaired consciousness	Diazepam	Consciousness improved immediately	Ozturk	[17]
25	50/F	Pneumonia, lung transplant, chronic myeloid leukemia	2.0	CKD	-	Nonverbal, unable to follow commands, myoclonic jerking	Lorazepam, levetiracetam	Mental status was normalized	Tchapyjnikov	[25]
26	28/F	Urinary tract infection, thoracic spina bifida, hydrocephalus (after ventriculoperitoneal shunt)	1.8	CKD	-	Confusion, twitching movements of both upper extremities	Lorazepam, valproic acid	Returned to her baseline health, EEGs did not reveal epileptiform discharges or electrographic seizures	Dixit	[23]
27	57/F	Heart failure, diabetes, ischemic cardiomyopathy	1.7	CKD	-	Loss of orientation, diminished speaking, difficulty following commands, visual hallucinations	Lorazepam	Mental status returned to baseline; EEG showed resolution of triphasic discharges	Tchapyjnikov	[25]
28	70/F	Pneumonia, lung transplant, a-1 antitrypsin deficiency	1.7	CKD	-	Disorientation, nonverbal, inability to follow commands	Discontinuation of cefepime only	Mental status normalized with associated resolution of triphasic wave discharges on EEG	Tchapyjnikov	[25]
29	72/F	Osteomyelitis, hypertension, hyperlipidemia, asthma, peripheral vascular disease, past breast cancer	1.6	CKD	-	Agitation, somnolence	Benzodiazepines	Mental status returned to normal	Lichaa	[26]
30	36/M	Urinary tract infection, nephrotic syndrome, past intracerebral hemorrhage	CCr 49 ml/min	CKD	-	Global aphasia, motor aphasia	Discontinuation of cefepime only	EEG and clinical symptoms made a gradual recovery	Kwon	[27]
31	60/M	Urinary tract infection, prostatic/hepatic abscess, critical illness polyneuropathy, pneumonia, after liver transplant	1.8	CKD	-	Reduction level of consciousness, myoclonic jerks	Midazolam	EEG confirmed moderate diffuse encephalopathy without epileptiform activity, died of severe heart failure	Fernández-Torre	[33]
32	79/F	Pneumonia	5.2	CKD	-	Confusion, myoclonus	Clonazepam, phenytoin, valproate	EEG and clinical improvement but died of heart failure	Martinez-Rodriguez	[15]
33	85/F	Pneumonia, late hemorrhagic cerebrovascular accident, diabetes mellitus, hypertension	1.5	CKD	-	Stupor	Diazepam	Status presentation and mental state did not improve	Ozturk	[17]
34	60/F	Ventilator-associated pneumonia, febrile neutropenia, myelodysplasia	CCr 12 ml/min	CKD	-	Facial convulsions	Valproic acid, phenytoin, levetiracetam	Died of intractable invasive aspergillosis	Spriet	[28]
35	54/M	Neutropenic fever, myelodysplasia	CCr 13 ml/min	CKD	-	NR	Valproic acid, phenytoin, phenobarbital	Neurologic status did not improve, died of septic shock	Spriet	[28]
36	74/M	Bronchopneumonia	10.1	AKI	Temporary HD	Stupor	Diazepam	Complete recovery of mental status, disappearance of paroxysmal activity on EEG paroxysmal activity on EEG	Primavera	[14]
37	40/F	Pyelonephritis, upper gastrointestinal bleed, acute hypoxic respiratory failure	5.1	AKI	Temporary HD	Twitching face and bilateral upper extremities	Lorazepam, levetiracetam, midazolam,	Twitching stopped and no further electrographic seizures or triphasic waves were seen on EEG	Oyenuga	[29]
38	65/M	Mediastinitis, esophageal carcinoma	3.2	AKI	Temporary HD	Confusion, myoclonus	Clonazepam, antiepileptic drugs	Complete recovery	Chatellier	[30]
39	71/F	Atypical pneumonia, lung cancer (after right lower lobe lobectomy), diabetes mellitus, hepatitis B viral infection	1.3	AKI	Temporary HD	Confusion, disorientation, stupor, generalized myoclonic seizure	Lorazepam, levetiracetam, valproic acid, phenytoin, clonazepam	EEG and clinical symptoms improved	Kim	[31]
40	65/F	Urinary tract infection, severe nephrolithiasis	CCr 20 ml/min	AKI	Temporary HD	Disorientation, dysarthria, myoclonus	Diazepam, valproic acid, levetiracetam	Regain previous mental condition, EEG perform normal	Suarez-de-la-rica	[32]
41	38/F	Neutropenia, allogenic bone marrow transplantation, hypernephroma	3.2	AKI	-	Agitation, disorientation	Diazepam, phenytoin, benzodiazepines	Completely controlled	Fernandez-Torre	[33]
42	76/F	Gangrenous pyoderma, neutropenia, chronic alcoholism	3.0	AKI	-	Agitation, alteration of consciousness level	Diazepam, phenytoin	Completely the epileptiform activity, mental status was normal	Fernandez-Torre	[33]
43	65/M	Nodular sclerosing Hodgkin's disease	2.8	AKI	-	Decreased level of consciousness, myoclonic jerks	Phenytoin	Neurological examination was normal, but a third relapse of Hodgkin's disease occurred and subsequently died	Plensa	[34]
44	43/M	Abdominal sepsis, congenital megacolon, chronic alcoholism	1.7	AKI	-	Abnormal behavior, severe mutism	Phenytoin	Experienced a dramatic clinical improvement	Fernandez-Torre	[33]
45	72/F	Pelvic osteomyelitis, diabetes, hypertension, chronic indwelling Foley catheter, coronary artery disease	1.2	AKI	-	Acute aphasia, confusion	Lorazepam, levetiracetam	Regained verbal function, EEG showed bi-hemispheric slowing but with no further evidence of seizure	Cunningham	[35]
46	66/F	Acute myeloid leukemia, pancytopenia, hyperlipidemia	CCr 30 ml/min	AKI	-	Confusion, myoclonic jerk	Clonazepam, valproic acid	EEG performed absence of epileptiform activity, regained consciousness	Abanades	[36]
47	73/F	Infection of knee prosthesis, rheumatoid, arthrosis	2.8	AKI	Temporary HD	Coma	Clonazepam, antiepileptic drugs	Died of multi-organ failure	Chatellier	[30]
48	55/F	Febrile neutropenia, pancytopenia after chemotherapy, refractory lymphoma	5.1	AKI	-	Loss of consciousness	Diazepam	Consciousness did not improve and died of sepsis	Ozturk	[17]
49	75/F	Pneumonia, congestive heart failure	2.2	AKI	-	Confusion	Diazepam, phenytoin	Died of sepsis and congestive heart failure	Ozturk	[17]

NCSE non-convulsive status epilepticus, CKD chronic kidney disease, HD hemodialysis, EEG electroencephalogram, NR not reported, PD peritoneal dialysis, AKI acute kidney injury, F female; M, male

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