Severe hyperkalaemia induced by trimethoprim in combination with an angiotensin-converting enzyme inhibitor in a patient with transplanted lungs.
A 40-year-old woman with transplanted lungs developed life threatening hyperkalaemia (6.8 mmol L-1) during high dose treatment with trimethoprim-sulfamethoxazole for Pneumocystis carinii pneumonia. Trimethoprim has an amiloride-like effect on the distal nephron and may thus induce hyperkalaemia, particularly if other contributing factors coexist. The present patient was also treated with the angiotensin-converting enzyme (ACE) inhibitor enalapril, and the combination of ACE-inhibition and potassium-sparing diuretics is known to induce hyperkalaemia. Hyperkalaemia was probably induced by the combination of ACE-inhibitor and trimethoprim, and this combination may be as dangerous as the combination of ACE-inhibitors with other potassium-sparing diuretics.
Bugge
J F
JF
Department of Anaesthesia, Rikshospitalet, Oslo, Norway.
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D000890:Anti-Infective Agents / Q000009:adverse effects*; D004656:Enalapril / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D016040:Lung Transplantation; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
D000806:Angiotensin-Converting Enzyme Inhibitors; D000890:Anti-Infective Agents; D004656:Enalapril; D015662:Trimethoprim, Sulfamethoxazole Drug Combination