Objective: To describe a mixed anticholinergic-type syndrome not previously associated with vancomycin in a patient with end-stage renal disease on hemodialysis, highlighting the impact of dosing and infusion rate errors. Case: A 61-year-old man with stage 5 chronic kidney disease on hemodialysis was admitted to the internal medicine unit for a catheter-related infection. Vancomycin was initiated at 1 g every 12 hours, infused at 16.6 mg/min. After four doses, the patient developed transient amaurosis, tachycardia, hyperthermia, xerostomia, xeroderma, confusion, agitation, and panic, consistent with a mixed anticholinergic-type syndrome. Symptoms resolved after discontinuation of vancomycin and subsequent hemodialysis. Discussion/Conclusions: This case demonstrates a definite association between vancomycin overdose with rapid infusion and the development of a mixed anticholinergic-type syndrome in a patient on hemodialysis. These findings underscore the importance of careful dose adjustment and strict control of infusion rates in advanced renal disease.
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