UMEM Educational Pearls

Category: Toxicology

Title: Bioaccumulation and the "Therapeutic" Overdose

Keywords: pharmacology (PubMed Search)

Posted: 1/23/2014 by Fermin Barrueto, MD (Updated: 9/23/2019)
Click here to contact Fermin Barrueto, MD

Everyone has admitted an altered mental status, patient or bradycardic patient and all of your test results are coming back normal except for a mild increase in creatinine. Take a look at the medication list. Creatinine is a poor indicator of renal function and GFR may be severely impaired even with a mild elevation of creatinine. If you have a predominantly renally excreted drug, you can see toxic effects of a drug even if administered at therapeutic levels.

Common bradycardia inducing medication that is renally cleared: atenolol (very high renal excretion) and digoxin (70%).

Altered Mental Status and on Keppra? Keppra is 100% renally cleared!

Ask your pharmacist for help with the medication list with renal or hepatic insufficiency.