Amphotericin B-induced nephrogenic diabetes insipidus in a case of cryptococcemia.
A 66-year-old woman with malignant lymphoma became neutropenic during chemotherapy and developed cryptococcemia. After amphotericin B had been commenced, she developed significant hypokalemia and polyuria, though her renal function remained stable. The laboratory findings showed no evidence of renal tubular acidosis. With vigorous water and potassium replacement, amphotericin B had been continued until the cumulative dose reached 2.5 g. After the cessation of amphotericin B, the hypokalemia and polyuria resolved promptly. Based on theses findings, she was diagnosed as nephrogenic diabetes insipidus with hypokalemia and without renal tubular acidosis due to amphotericin B. This complication is usually reversible, and vigorous water and potassium replacement may allow completion of treatment by amphotericin B, though careful monitoring of body water balance and renal function is of importance.
Fujita
Yukio
Y
Second Department of Internal Medicine, Nara Medical University, Japan.
Kasahara
Kei
K
Uno
Kenji
K
Konishi
Mitsuru
M
Maeda
Koichi
K
Yoshimoto
Eiichiro
E
Murakawa
Koichi
K
Mikasa
Keiichi
K
Amano
Itsuto
I
Morii
Takeshi
T
Kimura
Hiroshi
H
D000368:Aged; D000666:Amphotericin B / Q000009:adverse effects* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000097:blood; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D003453:Cryptococcosis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D003455:Cryptococcus neoformans / Q000276:immunology / Q000302:isolation & purification; D018500:Diabetes Insipidus, Nephrogenic / Q000139:chemically induced*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008223:Lymphoma / Q000150:complications / Q000188:drug therapy; D015122:Mercaptopurine / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents; D000946:Antigens, Fungal; D000964:Antimetabolites, Antineoplastic; D000666:Amphotericin B; D015122:Mercaptopurine