Response to “Cefepime-Induced Encephalopathy: A Possible Additional Mechanism of Neurotoxicity”

  • Han-Tao Li
  • Tony Wu
  • Wey-Ran Lin
  • Siew-Na LimEmail author
Response to Letter To The Editor

We thank Dr. Fernández-Fernández and Dr. Ameneiros-Lago for their interest in our article and appreciate their comment about another possible mechanism of cefepime neurotoxicity. Acquiring encephalopathy associated with carnitine deficiency has rarely been reported in the literature and mostly occurs in patients with a severe malnutrition state or other rare secondary causes [1, 2, 3]. The use of β-lactam antibiotics, quinolone antibiotics, specific anticancer drugs (etoposide, actinomycin D, and vinblastine), and omeprazole can cause the inhibition of carnitine reabsorption by organic cation transporter novel 2 (OCTN2) in the kidney [4]. Therefore, we believe that there is a possibility that after cefepime administration, carnitine deficiency may predispose to the development of acute encephalopathy symptoms. In clinical practice, it will be beneficial to test for serum and urine carnitine levels, especially in patients with exposure to cefepime treatment for a more extended period. Once a low serum carnitine level has been confirmed, oral carnitine supplementation may help to reverse the condition, in addition to early cefepime discontinuation.



  1. 1.
    Karakoc E, Erdem S, Sokmensuer C, Kansu T. Encephalopathy due to carnitine deficiency in an adult patient with gluten enteropathy. Clin Neurol Neurosurg. 2006;108(8):794–7.CrossRefGoogle Scholar
  2. 2.
    Limketkai BN, Zucker SD. Hyperammonemic encephalopathy caused by carnitine deficiency. J Gen Intern Med. 2008;23(2):210–3.CrossRefGoogle Scholar
  3. 3.
    Ling P, Lee DJ, Yoshida EM, Sirrs S. Carnitine deficiency presenting with encephalopathy and hyperammonemia in a patient receiving chronic enteral tube feeding: a case report. J Med Case Rep. 2012;6:227.CrossRefGoogle Scholar
  4. 4.
    Longo N, Frigeni M, Pasquali M. Carnitine transport and fatty acid oxidation. Biochim Biophys Acta. 2016;1863(10):2422–35.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2020

Authors and Affiliations

  1. 1.Section of Epilepsy, Department of NeurologyChang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of MedicineTaoyuanTaiwan
  2. 2.Department of Gastroenterology and HepatologyChang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of MedicineTaoyuanTaiwan

Personalised recommendations