Reversible Respiratory Paralysis Associated with Polymyxin Therapy

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Abstract
Eleven patients with respiratory paralysis associated with intramuscular poly-myxin B or colistin methanesulfonate were managed during a 2 1/2 year period. Clinical findings compared closely with 10 cases from the literature. Renal function impairment was an important underlying feature in almost all patients. Dyspnea and restlessness preceded apnea in all patients, and other neurologic abnormalities served as early warning signs in 2/3 the patients. Complete reversal of respiratory paralysis occurred usually within 24 hr. with only ventilatory supportive measures. Management included the use of intravenous Ca. Antibiotic-induced neuromuscular blockade mechanisms were reviewed, particularly with regard to the possible roles of Ca and of polymyxin-induced histamine release. Respiratory paralysis due to polymyxin and colistin is considered to be much more common than previously suspected.