Differential Diagnosis for Drug-Induced Seizures in WW

Single Most Likely Diagnosis

• Cefepime: Cefepime is a fourth-generation cephalosporin antibiotic known to cause neurotoxicity, including seizures, especially in patients with renal impairment or when given in high doses. Its potential to cause seizures is well-documented, making it a prime suspect in this case.

Other Likely Diagnoses

• Levothyroxine: Although less common, high doses of levothyroxine can lead to seizures, particularly if thyroid hormone levels become excessively elevated, leading to a hyperthyroid state. However, this is less directly associated with seizures compared to cefepime.
• Tirzepatide: While tirzepatide, a dual GIP and GLP-1 receptor agonist, is not commonly associated with seizures, any new medication introduction can potentially lower the seizure threshold, especially in susceptible individuals. However, direct evidence linking tirzepatide to seizures is limited.

Do Not Miss Diagnoses

• Metoprolol: Beta-blockers like metoprolol are not typically associated with causing seizures. However, in cases of overdose, they can lead to severe hypotension and potentially cerebral hypoperfusion, which might precipitate seizures in vulnerable patients. Although unlikely, missing an overdose scenario could be critical.

Rare Diagnoses

• Acetaminophen: Acetaminophen overdose is well-known for causing liver failure but is rarely associated with seizures directly. Seizures might occur in the context of a severe overdose leading to metabolic derangements, but this would be an uncommon presentation.
• Tirzepatide (as a rare cause): While mentioned under other likely diagnoses due to its novelty and potential to affect various physiological pathways, the actual risk of tirzepatide inducing seizures is considered rare and would require specific individual susceptibility or drug interactions.

It's crucial to evaluate the patient's renal function, especially when considering cefepime as the cause, and to review the dosages and blood levels of all medications to assess the likelihood of each potential cause. Additionally, other non-drug causes of seizures should be investigated to ensure a comprehensive approach to the patient's care.