myironlung Posted April 4, 2013 Share Posted April 4, 2013 Anyone experience using permethrin topical 5% for scabies and a subsequent increase in creatinine or decrease in gfr in an otherwise healthy young male adult after just one application? Just a shot in the dark. Creatinine 1.57 GFR non aa 52. No complaints other than some nasal congestion and intermittent dry cough for a few days. Usually reports GFR >60 and creatinine trending from 1.4 to 1.1 over past 4-5 yrs? Link to comment Share on other sites More sharing options...
Acebecker Posted April 4, 2013 Share Posted April 4, 2013 Nope. Used it in a variety of Pts, variety of ethnicities and ages. No noted concerns like what you're describing. Concommitant meds/drugs? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 4, 2013 Moderator Share Posted April 4, 2013 nope although stranger things have happened. likely incidental to use of permetherin. Link to comment Share on other sites More sharing options...
primadonna22274 Posted April 4, 2013 Share Posted April 4, 2013 I know it can happen with Lindane, in which about 10% of the topical dose is absorbed and later cleared renally about 5 days later (assuming normal renal function). This is a much bigger concern with little people and immature kidneys and there is a warning for systemic toxicity in infants, children and pregnant women. I imagine the process with permethrin is similar and it is probably also renally cleared. I think it's prudent just to have him hydrate well and recheck in a month. Link to comment Share on other sites More sharing options...
d2305 Posted April 5, 2013 Share Posted April 5, 2013 I tried to write for kwell shampoo, but its's gone. Link to comment Share on other sites More sharing options...
SocialMedicine Posted April 6, 2013 Share Posted April 6, 2013 elevated Cr as a result of VERY intense scratching? :heheh: Link to comment Share on other sites More sharing options...
d2305 Posted April 6, 2013 Share Posted April 6, 2013 Why did you check a cmp? Link to comment Share on other sites More sharing options...
Jonathan Yoder Posted April 6, 2013 Share Posted April 6, 2013 How big is he (would you expect his Cr to be higher because he has a lot of muscle mass)? Probably worth checking a UA with micro (although normal UA wouldn't rule out disease). The difference between 1.4 mg/dL and 1.57 mg/dL probably isn't a big deal, but if he has gone from 1.1 to 1.57 mg/dL in a fairly linear fashion over 4-5 yrs I would worried about underlying progressive kidney disease of some sort. Link to comment Share on other sites More sharing options...
myironlung Posted April 7, 2013 Author Share Posted April 7, 2013 This guy is pretty muscle bound, former college athlete and still strength trains, 6'2 210. Of course that rationale went through my head but I don't really have enough experience to know whether the whole "higher muscle mass" and increased creatinine theory holds true. I treated him for cellulitis maybe 4 months ago and his creatinine was 1.1. The reason I redrew a cmp this time around is cause 4 months ago his lfts were a little elevated. I suspected because of the antibiotics I put him on. He never came back for a repeat lab but since he was here the other day I was able to draw it on him. His lfts as I suspected were perfect. I did a quick urine dip which was normal. Overall it seems from his past that his creatinine jumps around, the highest being the last time of 1.57. Does anyone else see healthy muscular males with these up and down labs? Once again, I just don't have the experience or the interest right now to be analyzing something obscure like this. I just wanna make sure I treat him as I should. He takes no other meds aside from multivitamin, omega3, vit D and green tea. Link to comment Share on other sites More sharing options...
polarbebe Posted April 7, 2013 Share Posted April 7, 2013 "This guy is pretty muscle bound" Does he take PO creatine and is it possible this may affect his serum creatinine? :) Or any other dietary supplement to increase protein, could these affect his serum creatinine? It is not uncommon for people working on their muscles to take creatine or other protein supplements... I am completely unfamiliar with how they affect chemistries or are cleared. Also if he works out strenously and you check his labs right after, it may be possible theoretically that more creatinine is released into the blood due to the stress/lifting of weights from muscle breakdown? Link to comment Share on other sites More sharing options...
d2305 Posted April 7, 2013 Share Posted April 7, 2013 Yes, they take it and it affects LFTs and kidney function. Link to comment Share on other sites More sharing options...
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