Multifocal myoclonus secondary to tranexamic acid

Myoclonus is characterised by sudden and brief involuntary movements. We describe a patient who developed myoclonus and altered mental status following tranexamic acid overdose. The patient was a 61 year old man on chronic ambulatory peritoneal dialysis for adult polycystic kidney disease and had been prescribed lisinopril and metoprolol for long standing hypertension. He presented to hospital because of bloody effluent from his peritoneal catheter. Examination did not reveal any neurological abnormalities. Haemoglobin level was 6.2 g/dl, calcium 2.28 mmol/l, urea 20.3 mmol/l, and creatinine 1109 μmol/l, which was similar to the values taken one month before in the outpatient clinic (urea 20.2 mmol/l and creatinine 1112 μmol/l). Blood and peritoneal fluid were taken for microbiological analyses and were unrevealing. He was transfused two units of packed cells and started on oral tranexamic acid 500 mg four times daily in order to …