On 2017 Aug 31, Santosh Kondekar commented:

Though amikacin is known to be toxic at non therapeutic doses; I feel the toxicity with single high dose is questionable.

A fourteen month old child of a hospital staff nurse had presented to us with loose motions. Injection amikacin was advised along with routine supportive therapy for hydration. The dose of amikacin was advised as 7.5mg/kg/dose. The child had oliguria since last 12 hours. The amikacin injection was supposed to be kept on hold in view of same. Due to some miscommunication and advise being followed by a junior staff nurse and being unsuperwised; the child received an accidental overdose of intravenous amikacin bolus as 750 mg instead of 75.0 mg. The mishap was immediately noted by the mother. Mother being a staff nurse alerted the consultant and nephrologist. Immediately, blood was collected for renal profile, blood gas and amikacin levels. There was no acidosis on ABG and BUN was 24g/dl and Cr was 0.9. The child showed no worsening of symptoms nor any new symptoms like irritability,cry or seizures. A collective decision of consultant and parents was made to wait and watch. parents were informed all toxicities of amikacin in details. Child passed urine in subsequent hour. A repeat renal profile was sent after 6 hours and 24 hours. BUN was 22 and Serum Creatinine was 0.8. An audiometry was done after three months. A decision to perform dialysis was averted. Serum amikacin levels couldnot be done.

I do feel that; in normal renal profile, an accidental overdose upto ten times therapeutic dose in a child should not be a reason to panic and an apprehensive decision to perform hemodialysis can be avoided.

On 2017 Aug 31, Santosh Kondekar commented:

Though amikacin is known to be toxic at non therapeutic doses; I feel the toxicity with single high dose is questionable.

A fourteen month old child of a hospital staff nurse had presented to us with loose motions. Injection amikacin was advised along with routine supportive therapy for hydration. The dose of amikacin was advised as 7.5mg/kg/dose. The child had oliguria since last 12 hours. The amikacin injection was supposed to be kept on hold in view of same. Due to some miscommunication and advise being followed by a junior staff nurse and being unsuperwised; the child received an accidental overdose of intravenous amikacin bolus as 750 mg instead of 75.0 mg. The mishap was immediately noted by the mother. Mother being a staff nurse alerted the consultant and nephrologist. Immediately, blood was collected for renal profile, blood gas and amikacin levels. There was no acidosis on ABG and BUN was 24g/dl and Cr was 0.9. The child showed no worsening of symptoms nor any new symptoms like irritability,cry or seizures. A collective decision of consultant and parents was made to wait and watch. parents were informed all toxicities of amikacin in details. Child passed urine in subsequent hour. A repeat renal profile was sent after 6 hours and 24 hours. BUN was 22 and Serum Creatinine was 0.8. An audiometry was done after three months. A decision to perform dialysis was averted. Serum amikacin levels couldnot be done.

I do feel that; in normal renal profile, an accidental overdose upto ten times therapeutic dose in a child should not be a reason to panic and an apprehensive decision to perform hemodialysis can be avoided.