Altered mental status from acyclovir

The Journal of Emergency Medicine
Gabriel J Martinez-Diaz, Renee Hsia

Abstract

Acyclovir is widely used in the treatment of herpes virus infections, particularly herpes simplex virus and varicella-zoster virus. Acyclovir, when given promptly upon the start of a herpes zoster eruption, speeds healing and diminishes acute pain. Because acyclovir is a commonly used medication, it is crucial for health providers to be aware of appropriate dosing as well as possible side effects. We present this case to increase awareness of the potential for inappropriate dosing of acyclovir and the presentations of patients with toxic effects. We report the case of a 65-year-old man with a past medical history significant for chronic kidney disease who presented to the Emergency Department with progressive confusion and ataxia over 2 days. Thorough questioning in the patient's native language revealed that he had recently started a medication for a "rash." Neither he nor his family knew the name of the new medication; further investigation revealed it to be acyclovir. Although other diagnoses were considered in the differential diagnosis for this patient with altered mental status, he was treated for presumed acyclovir toxicity and given prompt dialysis, upon which his symptoms resolved. It is important for physicians to rem...Continue Reading

References

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Citations

Jul 16, 2013·Therapeutic Drug Monitoring·Mia von EulerAnders Helldén
Jun 20, 2014·American Journal of Therapeutics·Mohammed Andaleeb ChowdhuryRagheb Assaly
Mar 22, 2018·Frontiers in Aging Neuroscience·Steven A Harris, Elizabeth A Harris
Oct 13, 2020·Movement Disorders Clinical Practice·Suvorit S Bhowmick, Anthony E Lang
Jun 20, 2021·Journal of Clinical Pharmacy and Therapeutics·David Brandariz-NuñezIsabel Martín Herranz

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