title: Hyperkalemia associated with high-dose trimethoprim-sulfamethoxazole in a patient with the acquired immunodeficiency syndrome.
abstract: When given in standard dosages to treat bacterial respiratory and urinary tract infections, trimethoprim-sulfamethoxazole (TMP-SMX) is not commonly associated with hyperkalemia. However, the emergence of the acquired immunodeficiency syndrome has led to increased numbers of patients with Pneumocystis carinii pneumonia (PCP) who require high-dose TMP-SMX therapy. A 25-year-old man with human immunodeficiency virus infection developed hyperkalemia while receiving high-dose TMP-SMX for PCP. His baseline serum potassium of 3.0 mEq/L, which increased to 4.2 mEq/L after potassium replacement therapy, rose to 6.9 mEq/L after 8 days of TMP-SMX. No other etiology was found for the hyperkalemia, and the disorder resolved when TMP-SMX was stopped. It recurred when the patient was rechallenged with high doses of TMP-SMX during a second treatment course for PCP. This case and a review of previous reports highlight the importance of monitoring serum potassium concentrations in patients receiving high-dose TMP-SMX.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of Oklahoma, Oklahoma City, USA.
authors.forename: L B
authors.initials: LB
authors.lastname: Mihm
authors.forename: R C
authors.initials: RC
authors.lastname: Rathbun
authors.forename: B H
authors.initials: BH
authors.lastname: Resman-Targoff
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy; D011188:Potassium / Q000097:blood; D012008:Recurrence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D011188:Potassium