title: Life threatening hyperkalemia and acidosis secondary to trimethoprim-sulfamethoxazole treatment.
abstract: We present a 77-year-old male with moderate chronic renal insufficiency from diabetic nephropathy who developed severe metabolic acidosis and life threatening hyperkalemia on treatment with regular dose of trimethoprim-sulfamethoxazole (TMP-SMZ) for urinary tract infection. The metabolic acidosis and hyperkalemia resolved upon appropriate medical intervention and discontinuation of TMP-SMZ. While hyperkalemia has commonly been reported with high dose of TMP-SMZ, severe metabolic acidosis is quite uncommon with regular dose TMP-SMZ. We emphasize that patients with renal tubular acidosis (RTA), renal insufficiency, aldosterone deficiency, old age with reduced renal mass and function, and angiotensin converting enzyme (ACE)-inhibitor therapy are at high risk of developing these severe and potentially life threatening complications.
authors.affiliation: Department of Internal Medicine, Saint Louis University School of Medicine, Missouri 63110, USA.
authors.forename: S
authors.initials: S
authors.lastname: Margassery
authors.forename: B
authors.initials: B
authors.lastname: Bastani
mesh_terms: D000141:Acidosis, Renal Tubular / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D000368:Aged; D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects* / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004338:Drug Combinations; D005665:Furosemide / Q000008:administration & dosage; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000382:microbiology; D008297:Male; D011188:Potassium / Q000097:blood; D012083:Renin / Q000097:blood; D017693:Sodium Bicarbonate / Q000008:administration & dosage; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects* / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy
chemical_list: D000892:Anti-Infective Agents, Urinary; D004338:Drug Combinations; D005665:Furosemide; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D017693:Sodium Bicarbonate; D003404:Creatinine; D012083:Renin; D011188:Potassium