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Hyperkalemia associated with rapid infusion of conventional and lipid complex formulations of amphotericin B
1Legacy Emanuel Children's Hospital, and Northwest Pediatric Kidney Specialists, Portland, Oregon 97227, USA.
Insights
Rapid amphotericin B infusion can cause hyperkalemia, especially in patients with kidney issues. Lipid formulations may offer a safer alternative, as they have not been linked to this adverse effect.
Area of Science:
- Pharmacology
- Nephrology
- Pediatric Medicine
Background:
- Amphotericin B is a critical antifungal medication.
- Conventional amphotericin B deoxycholate carries risks, particularly with rapid administration.
- Renal impairment can exacerbate adverse effects.
Observation:
- Two pediatric cases highlight severe hyperkalemia and cardiac arrest following amphotericin B lipid complex and conventional amphotericin B deoxycholate infusions, respectively.
- Rapid infusion of amphotericin B was identified as a potential trigger for hyperkalemia.
- The risk of hyperkalemia appears elevated in patients with pre-existing renal failure.
Findings:
- Infusion rate is a critical factor in amphotericin B-induced hyperkalemia.
- Renal failure significantly potentiates the risk and severity of hyperkalemia.
- No hyperkalemia events have been reported with the lipid formulation of amphotericin B.
Implications:
- Clinicians should consider slower infusion rates for conventional amphotericin B deoxycholate.
- Careful patient selection and monitoring are crucial for those with renal impairment.
- Amphotericin B lipid complex may represent a safer alternative, particularly in high-risk populations.
Abstract:
A child developed hyperkalemia and cardiac arrest with infusion of an amphotericin B lipid complex 5.0 mg/kg over 1 hour. Another child, with chronic renal failure, developed hyperkalemia after infusion of conventional amphotericin B deoxycholate 1.0 mg/kg over 2 hours. Rapid infusion of the agent causes hyperkalemia in dogs and humans that is exacerbated in the setting of renal failure. A lipid formulation of amphotericin B is commercially available, and no reports of hyperkalemia are associated with its administration.