Possible liposomal amphotericin B-induced nephrogenic diabetes insipidus.
OBJECTIVE
To report the development of nephrogenic diabetes insipidus (NDI) associated with the use of high-dose liposomal amphotericin B.


METHODS
A 38-year-old white man with relapsed acute myelogenous leukemia underwent a matched unrelated donor allogeneic bone marrow transplant with adequate engraftment and mild graft-versus-host disease responding to corticosteroids. Approximately 11 months after transplant, the patient was admitted to the hospital with suspected fungal pneumonia and started on liposomal amphotericin B (baseline serum creatinine 1.4-1.5 mg/dL). The dose was increased due to his immunosuppression and poor response, as the fungal etiology was identified as Torulopsis glabrata. The patient required mechanical ventilation due to biopsy-proven bronchiolitis olbiterans organizing pneumonia. Additionally, he developed diffuse alveolar hemorrhage and received intravenous desmopressin, with a reduction in bloody secretions. He also developed hypernatremia (serum sodium 155 mEq/L) on day 3 of the desmopressin and had an inappropriately increased urine output consistent with NDI. The most likely etiology for the NDI was liposomal amphotericin B and its associated hypokalemia.


CONCLUSIONS
The observation of worsening hypernatremia (serum sodium increased from 135 to 164 mEq/L) with polyuria was associated with an increasing cumulative dosage of liposomal amphotericin B for fungal pneumonia despite the concurrent use of intravenous desmopressin. Aggressive water replacement was an effective treatment option in this patient. The Naranjo probability scale classified this as a possible adverse reaction because of the temporal sequence of NDI after high-dose liposomal amphotericin B and previously reported cases of NDI associated with amphotericin B desoxycholate.


CONCLUSIONS
Amphotericin B desoxycholate has been implicated as an etiology for NDI, and the use of the newer liposomal amphotericin B reportedly avoids this rare complication. We observed the development of NDI despite the use of liposomal amphotericin B in a critically ill patient with bone marrow transplant.
Canada
Todd W
TW
Division of Pharmacy, Unit 90, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA. tcanada@mdanderson.org
Weavind
Lisa M
LM
Augustin
Kristan M
KM
D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D041221:Candida glabrata; D018500:Diabetes Insipidus, Nephrogenic / Q000139:chemically induced* / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007275:Injections, Intravenous; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D008297:Male; D011014:Pneumonia / Q000188:drug therapy / Q000382:microbiology
D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B