Intravenous aciclovir can crystallise in the renal tubules, causing an acute kidney injury that usually appears within the first days. The risk is higher with dehydration, rapid infusion, high doses and existing kidney disease — all common on the medical take.
Give it over at least an hour with adequate fluids, adjust the dose to renal function, and recheck creatinine during the course. In obesity, dose on ideal rather than actual body weight. Neurotoxicity, with confusion or tremor, can mimic the encephalitis being treated, especially when renal function falls.
- Infuse intravenous aciclovir over at least one hour and keep the patient well hydrated.
- Adjust the dose to estimated renal function and recheck creatinine within the first few days.
- Dose on ideal body weight in obesity.
- Consider aciclovir neurotoxicity if confusion worsens as creatinine rises.
Why it matters
Starting aciclovir early is the priority; this keeps the early dose from causing kidney injury.
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