• Nawwar Soliman, Mohammad Alsultan, Ayham Alhusseini, Omar Alsamarrai, and Kassem Basha.
• Department of Internal Medicine, Al Assad and Al Mouwasat University Hospitals, Damascus University, Faculty of Medicine, Damascus, Syria.
• Medicine (Baltimore). 2024 Feb 23; 103 (8): e36834e36834.

RationaleRhabdomyolysis is a serious complication of status epilepticus (SE) caused by muscle cell damage and can lead to a life-threatening acute kidney injury (AKI).Patient ConcernsA 35-year-old man with a history of seizures treated with 3 different antiepileptic drugs (carbamazepine, lamotrigine, and levetiracetam) presented with SE. The patient received 5 doses of diazepam to control the SE in another hospital and was transferred to our emergency due to AKI.DiagnosesLaboratory tests corresponded with rhabdomyolysis-induced AKI and disseminated intravascular coagulation. Thereafter, the decrease in renal excretion of both drugs (diazepam and carbamazepine) caused acute liver injury and neurotoxicity. The carbamazepine concentration was 16.39 mcg/mL, which considered in toxic level, despite using the usual dose.InterventionsThe patient was treated with hydration and sodium bicarbonate, however; severe AKI mandated a hemodialysis session.OutcomesThe diuresis started to increase, kidney and liver functions improved, and altered mental status reversed.LessonsThis case alerts physicians to consider the synergistic drug side effects and interactions, especially when patients present with impaired liver or kidney functions. The reduction in metabolism or excretion of drugs can cause an increase in serum concentrations and induce toxicity, even when the drug intake at the usual dose.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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