Page 165 - Abstract Book KONIKA 18

Emergency & Pediatric Intensive Care

P-EPIC-010
Acute Myoclonus following Diphenhydramine Administration:
A Rare Case in Adolescent

Pustika Efar, Felix Liauw, Raden Anna Tjandrajani, Endang Lestari Andayani
Department of Child Health, Harapan Kita Women and Children Hospital, Jakarta, Indonesia

Abstract
Background Myoclonus is an involuntary jerky contraction of muscles. Only few literatures showed drug-
induced myoclonus. Objective To describe a case of myoclonus triggered by first-generation antihistamine,
diphenhydramine. Case Our patient was a 17-year-old girl, 32 kg, with lupus nephritis, dilated cardiomyopathy,
and hypertension. She was admitted to intensive care unit due to pneumonia and heart failure. Cefotaxime was
prescribed, along with her routine drugs (methylprednisolone, mycophenolate mofetil, hydroxychloroquine,
digoxin, carvedilol, amlodipine, ramipril). After receiving 5th injection of cefotaxime, she showed signs
of angioedema. Allergy to cefotaxime was suspected, and intravenous diphenhydramine 30 mg (1 mg/
kgBW) was administered. Thirty minutes later, the allergic reaction was subsided, but she reported jerky
movements of her legs. The jerks were mostly bilateral, with 10-15 seconds interval between jerks. Her
face, trunk, and upper extremities were not involved. She was fully alert and had stable vital sign. No history
of seizure nor epilepsy was found. During observation, she could not control the involuntary movement
and had sleeping difficulty because the jerks were disturbing and painful. We suspected an antihistamine-
induced myoclonus, hence we administered intravenous diazepam 0.1 mg/kgBW and the symptoms resolved
completely. Diphenhydramine was discontinued. A week later, she was readmitted for therapeutic plasma
exchange. Diphenhydramine and dexamethasone was prescribed as premedication. The jerky movements
were recurred on both legs and resolved spontaneously after plasma exchange. Our patient did not consume
opiates, antidepressants, nor antipsychotics. Conclusion Myoclonus might be an idiosyncratic drug reaction
occurred in therapeutic dose of diphenhydramine. Since antihistamine is commonly prescribed for pediatric
patients, myoclonus as a possible adverse effect of diphenhydramine should be anticipated.
Keywords: myoclonus; seizure; diphenhydramine

P-EPIC-011
Acute Kidney Injury as Prognostic Factor Septic Shock
in Pediatric Intensive Care Unit

Akima Ramadhani Tahir, Idham Jaya Ganda, Dasril Daud
Department of Child Health, Faculty of Medicine Universitas Hasanuddin, Makassar, South Sulawesi, Indonesia
Abstract
Background Septic shock mortality and morbidity rate had increased in several decades. It is possible that
septic shock can cause Acute Kidney Injury (AKI). This study aims to understand AKI as a prognostic factor
to the outcome of septic shock patients in Pediatric Intensive Care Unit. This study has never been done in
South Sulawesi. Objective To know the relationship of AKI with the outcome of septic shock patients in
Pediatric Intensive Care Unit. Methods This study was a cohort retrospective study, for children of 1 month-18
years of age in pediatric intensive care unit of Dr Wahidin Sudirohusodo Hospital, Makassar. Sampling
was taken from the medical records of those who fulfilled the inclusion category. These cases were divided
into AKI-induced septic shock data and non AKI induced-septic shock data. The data were then analyzed
with multivariate analysis and multiple regresion formula to predict the outcome. Results From 90 samples
of septic shock patients, prevalence of AKI induced septic shock is as follow: 3 (10.3%) survived and 26
(89.7%) not survived. Meanwhile, prevalence of non AKI induced septic shock: 32 (52.5%) survived and
29 (47.5%) not survived. The result showed that there is a relationship of AKI to the septic shock outcome,
at P=0.001 and that it is a prognostic factor to the septic shock outcome in pediatric intensif care unit with
AOR 9,250, 95%CI (2,518-34,382). Conclusion AKI is a prognostic factor of septic shock patients in the
pediatric intensif care unit.
Keywords: AKI; septic shock; outcome

KONIKA XVIII Abstract Book 117