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Cholestyramine-induced hyperchloremic metabolic acidosis.
P J Scheel1, A Whelton, K Rossiter
1Division of Nephrology, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21205.
Journal of Clinical Pharmacology
|June 11, 1992
Summary
Cholestyramine, used for high cholesterol and diarrhea, can cause severe metabolic acidosis. Patients with kidney issues, dehydration, or on spironolactone require careful monitoring for this serious side effect.
Area of Science:
- Nephrology
- Clinical Pharmacology
- Internal Medicine
Background:
- Cholestyramine is a widely prescribed anion exchange resin for hypercholesterolemia and diarrhea.
- Its nonabsorbable nature is key to its therapeutic action.
- Understanding its metabolic effects is crucial for patient safety.
Observation:
- Two cases of severe hyperchloremic nonanion gap metabolic acidosis were observed.
- These adverse events were directly linked to cholestyramine therapy.
- The acidosis presented as a significant disruption of acid-base balance.
Findings:
- Cholestyramine use can precipitate severe metabolic acidosis.
- This complication is characterized by hyperchloremia and a nonanion gap.
- Risk factors include renal insufficiency, volume depletion, and spironolactone co-administration.
Implications:
- Clinicians should be vigilant for metabolic acidosis in patients on cholestyramine.
- Monitoring is essential for patients with risk factors like kidney disease or dehydration.
- Early detection and management can prevent severe complications of acid-base imbalance.