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Aminoglycoside-associated hypomagnesaemia in children with cystic fibrosis
A Akbar1, J H Rees, G Nyamugunduru
1Paediatric Respiratory and Cystic Fibrosis Unit, The Birmingham Children's Hospital NHS Trust, UK.
Insights
Hypomagnesaemia, low magnesium levels, is a risk for children with cystic fibrosis (CF) treated with aminoglycosides. Regular serum magnesium screening is recommended for CF patients receiving multiple aminoglycoside courses.
Area of Science:
- Pediatric Nephrology
- Pulmonology
- Clinical Pharmacy
Background:
- Cystic Fibrosis (CF) management often involves intravenous aminoglycosides for bacterial infections.
- Aminoglycoside nephrotoxicity is a known complication, but its role in magnesium wasting is under-recognized.
- Hypomagnesaemia can exacerbate other CF-related complications.
Observation:
- A case of significant hypomagnesaemia in a pediatric cystic fibrosis patient post-intravenous aminoglycoside therapy for Pseudomonas aeruginosa infection.
- Three additional similar cases were identified.
- Renal magnesium wasting was confirmed in two of the affected patients.
Findings:
- Repeated courses of intravenous aminoglycosides may cause cumulative renal tubular damage.
- This damage can lead to excessive renal loss of magnesium, resulting in hypomagnesaemia.
- Hypomagnesaemia appears to be an under-recognized complication in pediatric CF patients undergoing extensive aminoglycoside treatment.
Implications:
- Routine serum magnesium monitoring should be implemented for cystic fibrosis patients receiving multiple aminoglycoside courses.
- Early detection and management of hypomagnesaemia can prevent further complications.
- This highlights the importance of considering electrolyte disturbances in CF patients with prolonged antibiotic therapy.
Abstract:
Hypomagnesaemia in children with cystic fibrosis (CF) is under-recognized. We report a child with CF who developed significant hypomagnesaemia following intravenous (i.v.) treatment with aminoglycosides for exacerbations of Pseudomonas aeruginosa infection. Three additional cases have also been observed. Investigations in two patients have revealed excessive renal loss of magnesium. It is postulated that renal tubular damage secondary to the cumulative effects of repeated courses of aminoglycosides resulted in hypomagnesaemia, and we suggest screening for this problem by monitoring serum magnesium regularly in all patients with CF receiving multiple courses of aminoglycosides.