Question

Case Analysis

An 88-y.o. woman with dementia, a history of hypertension and coronary artery disease (post coronary artery bypass graft) was sent from her nursing home to the Emergency Department for worsening confusion. She had been admitted to the hospital six-weeks earlier and treated for urosepsis, at which time an allergy to levofloxacin was noted.

Initial evaluation revealed leukocytosis and pyuria, but no fever or flank pain. The ER doctor concluded that a urinary tract infection was the most likely cause of the patient’s altered mental status and elected to treat her with levofloxacin.

The first dose was administered on the medical floor shortly after the patient arrived. Over the next six hours, the patient became increasingly agitated and required sedation and restraint. She developed a diffuse erythematous rash.

1. What happened? Proximate Cause

2. Why did this happen? Contributing Factors

3. Risk reduction strategy. Action Plan.

Answer 1

1 . The patient is an elderly lady who is 88 year old with dementia. She is allergic to levofloxacin. People who are allergic to levofloxacin develop anaphylactic reactions after the first dose which is associated with delirium. Levofloxacin is quinolone derivative which has adverse reactions on the central nervous system . That is the reason for agitation and restraint requirement in this patient.

2 . It happened because of the anaphylaxis of levofloxacin. The contributing factors include hypertension, dementia, old age, urosepsis and coronary artery disease.

3. Test dose of levofloxacin can be given before administration to prevent the anaphylaxis reaction. Now , since the anaphylaxis is developed, anti -allergic medications like histamine is given inorder to prevent the further complications like anaphylactic shock. The patient is calmed with anti- anxiety drugs and sedatives inorder to keep her calm and reduce the agitation.

Thank you.