Hospital Acquired Delirium with Myoclonus Secondary to Famotidine (P02.043)

Abstract

Objective: Hospital acquired delirium is a common clinical problem leading to significant morbidity and increase health care costs. Recognition of different causes of hospital acquired delirium can be useful in minimizing the adverse outcomes. Background Famotidine is a H2 blocker commonly used for stress ulcer prophylaxis in hospitalized patients. We describe a patient, with delirium and myoclonus following Famotidine use, resulting in significant morbidity, extensive work up and prolong hospital stay. Discontinuation of Famotidine resulted in complete resolution of symptoms and return to baseline mental status. Design/Methods: An 82 year old woman was hospitalized following an episode of transient word finding difficulty. Famotidine 20mg twice a day was prescribed on admission. She was due to be discharged two days later when she developed change in mental status. She became confused, disoriented, agitated with an incomprehensible speech pattern. Myoclonus was noted in both upper extremities, right more than the left. She had visual hallucinations, became agitated and paranoid and required chemical as well as physical restraints to keep her safe. Results: Common metabolic causes of delirium were excluded (chemistry panel, thyroid, B12, infection). Her only home medications were Keppra (recently added) and warfarin. Keppra was stopped and Dilantin was added. When symptoms persisted a LP was done which showed protein of 87, glucose 88, WBC 3, RBC 9. CSF cytology, paraneoplastic panel, RPR, Lyme, TPO antibody as well s 14-3-3 was negative. CT brain, CTA head and neck were unremarkable. Famotidine was discontinued which resulted in significant improvement in symptoms within 2 days and complete resolution of symptoms within a week. Conclusions: Hospital acquired delirium is a common clinical problem in the elderly. Famotidine is commonly prescribed in hospitalized patients. Famotidine can cause delirium with myoclonus and this should be included in the differential of delirium to avoid extensive investigation and stopped immediately. Disclosure: Dr. Wijemanne has nothing to disclose. Dr. Hinchey has nothing to disclose.