Related Experiment Videos
Risk factors of ventricular fibrillation during rapid amphotericin B infusion
Abstract:
Amphotericin B causes reversible concentration-dependent loss of intracellular potassium in vitro and hyperkalemic ventricular arrhythmias in dogs. Hyperkalemic ventricular arrhythmias associated with amphotericin B infusion have not been well documented in humans. Ventricular fibrillation with progressive hyperkalemia (up to 8 to 8.4 meq/liter) occurred twice in an anuric patient during rapid infusion of high-dose amphotericin B (1.4 mg/kg over 45 min). The peak amphotericin B concentration in serum at the end of infusion was 6.7 micrograms/ml. Prolonged infusion (3 h) and concurrent hemodialysis each prevented the development of hyperkalemia and ventricular arrhythmia. In two anuric patients receiving 4-h infusions of amphotericin B during dialysis (0.7 and 1.0 mg/kg), peak amphotericin B concentrations in serum were lower, 1.6 +/- 0.1 and 2.7 +/- 0.7 micrograms/ml, respectively; serum potassium levels were maintained in the normal range; and venous access for outpatient therapy was convenient. Peak concentrations of amphotericin B in serum were also lower (1.7 +/- 0.7 micrograms/ml) in eight patients with normal renal function who received lower doses (0.7 +/- 0.2 mg/kg) over 45 min; there were only slight increases in the serum potassium level (from 3.9 +/- 0.9 to 4.4 +/- 0.6 meq/liter, P less than 0.05). We recommend that rapid infusion of amphotericin B not be used in patients with impaired potassium excretion unless accompanied by hemodialysis and careful potassium monitoring.
Insights
Rapid amphotericin B infusions can cause dangerous hyperkalemia and arrhythmias in patients with kidney problems. Slowing infusion rates or using hemodialysis prevents these severe adverse events.
Area of Science:
- Pharmacology
- Nephrology
- Cardiology
Background:
- Amphotericin B is known to cause potassium loss in vitro and arrhythmias in dogs.
- Human cases of amphotericin B-induced hyperkalemic ventricular arrhythmias are rare.
- This study investigates the safety of amphotericin B infusion in patients with impaired renal function.
Observation:
- A patient with anuria experienced ventricular fibrillation and severe hyperkalemia during rapid, high-dose amphotericin B infusion.
- Prolonged infusion (3 hours) and concurrent hemodialysis prevented hyperkalemia and arrhythmias in anuric patients.
- Lower peak serum concentrations of amphotericin B were observed with slower infusions or during dialysis.
Findings:
- Rapid amphotericin B infusion (1.4 mg/kg over 45 min) led to peak serum concentrations of 6.7 µg/ml and ventricular fibrillation in an anuric patient.
- Slower infusions (3-4 hours) or hemodialysis during infusion maintained normal serum potassium levels and prevented arrhythmias.
- Patients with normal renal function receiving lower doses over 45 min showed only minor potassium increases.
Implications:
- Rapid amphotericin B infusion is associated with significant risk of hyperkalemia and ventricular arrhythmias in patients with impaired potassium excretion.
- Hemodialysis and careful potassium monitoring are crucial for anuric patients receiving amphotericin B.
- Adjusting infusion rates and considering concurrent hemodialysis can mitigate the risk of severe adverse cardiac events.