Hypokalemia among patients receiving treatment for multidrug-resistant tuberculosis.
BACKGROUND
Between January 1999 and December 2000, 125 patients in Lima, Peru were enrolled in individualized treatment for multidrug-resistant tuberculosis (MDR-TB). Hypokalemia was observed to be an important adverse effect encountered in this cohort.


OBJECTIVE
To identify risk factors associated with the development and persistence of hypokalemia during MDR-TB therapy, and to review the incidence and management of hypokalemia in patients receiving MDR-TB therapy.


METHODS
A retrospective case series of 125 patients who received individualized therapy for MDR-TB between January 1, 1999, and December 31, 2000.


RESULTS
Among 115 patients who were screened for electrolyte abnormalities, 31.3% had hypokalemia, defined as a potassium level of < 3.5 mEq/L. Mean serum potassium at time of diagnosis was 2.85 mEq/L. Diagnosis of low serum potassium occurred, on average, after 5.1 months of individualized therapy. Multivariate analysis of risk factors for this adverse reaction identified two causes: administration of capreomycin, and low initial body weight. Normalization of potassium levels was achieved in 86% of patients.


CONCLUSIONS
Electrolyte disturbance was frequently encountered in our cohort of patients with MDR-TB. Successful screening and management of hypokalemia was facilitated by training the health-care team in the use of a standardized algorithm. Morbidity from hypokalemia can be significant; however, effective management of this side effect is possible without sacrificing MDR-TB treatment efficacy.
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA. sshin@partners.org
Sonya
S
Shin
Jennifer
J
Furin
Félix
F
Alcántara
Anne
A
Hyson
Keith
K
Joseph
Epifanio
E
Sánchez
Michael
M
Rich
D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002207:Capreomycin / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced*; D008274:Magnesium / Q000097:blood; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000097:blood / Q000188:drug therapy*
D000995:Antitubercular Agents; D002207:Capreomycin; D008274:Magnesium