Severe injury to kidneys and brain following sulfathiazole administration; high serum sodium and chloride levels and persistent cerebral damage

Abstract

FIVE patients with a history of recent sulfonamide medication have de-veloped an unusual type of renal insufficiency, as well as evidence of injury to the brain. The patients presented a temporary, severe disturbance of serum sodium and chloride concentration, which was responsible, at least in part, for the death of two patients. In all cases there were signs of injury to the central nervous system, which persisted in two patients despite return of the blood chemistry to normal. Case 1. This 25 year old colored laborer was brought to the hospital because of vomiting and delirium. His past health had been good. Ten days before admission he complained of fever, cough, and pain in the chest. Three days later his physician found signs of pneumonia and prescribed sulfathiazole, 3 grams per day for two days and then 1.5 grams per day for four more days. On the second day of treatment, the patient began to vomit. After three days of sulfathiazole therapy, he retained no food or fluids and passed little or no urine. He became drowsy, confused, and finally delirious