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Case report: reversible hyperkalemia associated with trimethoprim- sulfamethoxazole
1Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109, USA.
Abstract:
Trimethoprim-sulfamethoxazole (TMP-SMX) is a fixed-dose antimicrobial agent used in a variety of infections. Adverse reactions are more common in patients with AIDS, but occasionally occur in immunocompetent patients. Renal toxicity is usually a hypersensitivity reaction to the sulfa component, and manifests as interstitial nephritis or sulfa crystallization in the renal tubules. Reversible hyperkalemia is a rarely reported side effect of TMP-SMX therapy attributed to TMP inhibition of potassium secretion in the distal renal tubule in a manner similar to the potassium sparing diuretic, amiloride. In this article, the author reports a case of hyperkalemia associated with TMP-SMK occurring in an elderly man with no other risk factors for hyperkalemia, which resolved upon discontinuation of the drug.
Insights
Trimethoprim-sulfamethoxazole can cause hyperkalemia, a rare side effect. This study details a case in an elderly man, highlighting the need for monitoring potassium levels during antibiotic treatment.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Trimethoprim-sulfamethoxazole (TMP-SMX) is a widely used antibiotic for various infections.
- Adverse reactions to TMP-SMX can occur, particularly in immunocompromised individuals, but also in immunocompetent patients.
- Renal toxicity, including interstitial nephritis and crystalluria, is a known complication, typically a hypersensitivity reaction to the sulfa component.
Observation:
- Hyperkalemia, a reversible side effect, has been rarely reported with TMP-SMX therapy.
- This effect is attributed to the trimethoprim component inhibiting potassium secretion in the distal renal tubule.
- The mechanism is similar to potassium-sparing diuretics like amiloride.
Findings:
- This article presents a case of TMP-SMX-induced hyperkalemia in an elderly male patient.
- The patient had no pre-existing risk factors for hyperkalemia.
- The hyperkalemia resolved upon discontinuation of TMP-SMX therapy.
Implications:
- This case underscores the potential for TMP-SMX to cause hyperkalemia, even in patients without typical risk factors.
- Clinicians should consider monitoring serum potassium levels in patients receiving TMP-SMX, especially the elderly.
- Awareness of this rare but significant adverse effect is crucial for safe antimicrobial prescribing.