<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2184-0628</journal-id>
<journal-title><![CDATA[Gazeta Médica]]></journal-title>
<abbrev-journal-title><![CDATA[Gaz Med]]></abbrev-journal-title>
<issn>2184-0628</issn>
<publisher>
<publisher-name><![CDATA[Círculo Médico]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2184-06282022000100084</article-id>
<article-id pub-id-type="doi">10.29315/gm.v1i1.543</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Ertapenem-Induced Delirium]]></article-title>
<article-title xml:lang="pt"><![CDATA[Delirium Induzido pelo Ertapenem]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bilreiro]]></surname>
<given-names><![CDATA[Mariana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Correia]]></surname>
<given-names><![CDATA[Luís Marote]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Central do Funchal Serviço de Medicina Interna ]]></institution>
<addr-line><![CDATA[Funchal ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>03</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>03</month>
<year>2022</year>
</pub-date>
<volume>9</volume>
<numero>1</numero>
<fpage>84</fpage>
<lpage>89</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2184-06282022000100084&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2184-06282022000100084&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2184-06282022000100084&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract Neurotoxicity is an unusual iatrogenic effect associated with carbapenems, typically manifested as seizures or hyperactive delirium. We present an 89-year-old female patient with a medical history of hypertension and chronic kidney disease who was admitted for acute tracheobronchitis and anemia related to diverticular disease. As a complication, she developed acute cystitis caused by extended spectrum &#946;-lactamases producing Klebsiella pneumoniae, so intravenous ertapenem was started. On the second day of antibiotic therapy, the patient manifested visual hallucinations followed by an inattentive and lethargic state suggestive of a hypoactive delirium. An ertapenem-induced neurotoxicity was suspected. Upon substitution by meropenem, the patient improved, and symptom reversal occurred after 72 hours. We present a review of ertapenem-induced hallucinations and address pharmacokinetics aspects namely renal dysfunction and hypoalbuminemia that could potentiate encephalopathy. Although rare, clinicians should be aware of non-seizure ertapenem related neurotoxicity. Ready recognition can lead to rapid improvement and prevent dire outcomes.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo A neurotoxicidade é um efeito iatrogénico incomum relacionado com carbapenemes, tipicamente manifestado através de convulsões ou delirium hiperativo. Relatamos o caso de uma doente de 89 anos com história de hipertensão arterial e doença renal crónica internada por taqueobronquite aguda e anemia devida a doença diverticular. Como intercorrência apresentou cistite aguda por Klebsiella pneumoniae produtora de &#946;-lactamases de espectro estendido, tendo iniciado ertapenem endovenoso. Ao segundo dia dessa antibioterapia manifestou alucinações visuais seguidas de estado de inatenção e letargia, sugestivo de delirium hipoativo. Suspeitámos de neurotoxicidade ao ertapenem. Com a substituição por meropenem, assistiu-se a melhoria com reversão sintomática após 72 horas. Revimos casos de alucinações induzidas pelo ertapenem e salientamos aspetos farmacocinéticos nomeadamente a disfunção renal e a hipoalbuminemia potenciadores da encefalopatia. Apesar de raro, os clínicos devem estar alerta para a neurotoxicidade não-convulsiva relacionada com o ertapenem. O reconhecimento atempado facilita a reversão e previne complicações deletérias.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Alucinações/induzido quimicamente]]></kwd>
<kwd lng="pt"><![CDATA[Delírio/induzido quimicamente]]></kwd>
<kwd lng="pt"><![CDATA[Ertapenem/efeitos adversos]]></kwd>
<kwd lng="en"><![CDATA[Delirium/chemically induced]]></kwd>
<kwd lng="en"><![CDATA[Ertapenem/adverse effects]]></kwd>
<kwd lng="en"><![CDATA[Hallucinations/chemically induced]]></kwd>
</kwd-group>
</article-meta>
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