A 64-year-old female with history of type II DM with end stage renal disease on hemodialysis was recently discharged from the hospital after treating for sepsis with Methicillin Resistant Staphylococcus Aureus (MRSA). During the hospitalization she received renal adjusted dose of vancomycin and ceftriaxone. She also developed severe muscle cramps during dialysis and was started on quinine. Her other medications include insulin for DM and hydrochlorothiazide plus metoprolol for hypertension. Since the time of discharge she has been complaining of a perception of an internal noise in her left ear. The most likely medication responsible for her condition is:
A. Ceftriaxone
B. Quinine
C. Vancomycin
D. Hydrochlorothiazide
E. Metoprolol
Explanation:
Tinnitus can sometimes occur in patients taking aspirin, quinine, and even in patients who are depressed. It may be a feature of Ménière’s disease and acoustic neuroma. It can cause disruption of sleep, concentration and depression. Tricyclic anti-depressants have been found to be effective for this condition. For decades quinine is being used for treating cramps in dialysis patients. Only one double-blind placebo controlled trial of nine hemodialysis patients has shown its beneficial affect.
Choice A: Ceftriaxone does not produce tinnitus.
Choice C: Vancomycin can cause nephrotoxicity and the red man syndrome (due to histamine release from mast cells), but does not cause tinnitus.
Choice D: Hydrochlorothiazide is a diuretic agent, which does not cause tinnitus.
Choice E: Metoprolol is a beta-blocker, which does not cause tinnitus.
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