In this episode, I’ll discuss a case report of seizures precipitated by esmolol in sterile water formulation.
A case report recently published in American Journal of Health-System Pharmacy highlights the potential for a drug diluent to have significant adverse clinical consequences.
The case is that of a 34-year-old male who was admitted for type A aortic dissection and treated with an esmolol infusion and operative repair. Two days after starting treatment with esmolol infusion, the patient developed seizures and clinicians treated the patient with anti-epileptics. However it was found that the patient’s serum sodium concentration dropped by 14 mEq/L since their initial labs on admission. Over the 2 days of treatment the patient had actually received 6 liters of esmolol in sterile water. At the time this was discovered the team switched antihypertensives and started an infusion of normal saline. The patient’s serum sodium recovered, antiepileptics were discontinued, and no further seizure activity was noted.
The authors emphasize the importance of being aware of the formulation and excipients of medications and their potential for adverse effects.
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