Vancomycin Overdose and Infusion Rate Error Leading to a Mixed Anticholinergic-Type Syndrome in a Hemodialysis Patient: A Case Report

<b>Objective:</b> To describe a mixed anticholinergic-type syndrome not previously associated with vancomycin in a patient with end-stage renal disease on hemodialysis, highlighting the impact of dosing and infusion rate errors. <b>Case:</b> A 61-year-old man with stage 5 chronic kidney disease on hemodialysis was admitted to the internal medicine unit for a catheter-related infection. Vancomycin was initiated at 1 g every 12 hours, infused at 16.6 mg/min. After four doses, the patient developed transient amaurosis, tachycardia, hyperthermia, xerostomia, xeroderma, confusion, agitation, and panic, consistent with a mixed anticholinergic-type syndrome. Symptoms resolved after discontinuation of vancomycin and subsequent hemodialysis. <b>Discussion/Conclusions:</b> This case demonstrates a definite association between vancomycin overdose with rapid infusion and the development of a mixed anticholinergic-type syndrome in a patient on hemodialysis. These findings underscore the importance of careful dose adjustment and strict control of infusion rates in advanced renal disease.