title: Life-threatening hyperkalemia: a potentially lethal drug combination.
abstract: Hyperkalemia is commonly seen in the elderly and is occasionally fatal. Inadvertently combining potassium sparing medications can result in profound hyperkalemia which may result in cardiac dysrhythmias, especially in the setting of chronic kidney disease. An 85 year-old woman on a drug regimen of sotalol, valsartan, spironolactone, and trimethoprim-sulfamethoxazole presented to the emergency department with hypotension and bradycardia. Presumptive treatment for hyperkalemia was started based on her initial electrocardiogram. This diagnosis was later confirmed with a serum potassium value of 10.1 mmol/L. Following pharmacologic treatment, emergency hemodialysis was performed and the patient subsequently recovered. It is known that several drug classes can cause hyperkalemia, with elderly patients at a higher risk of developing this side effect. It is believed that this was a major contributor to the degree of hyperkalemia seen in this patient.
authors.affiliation: Department of Internal Medicine, Bridgeport Hospital, Bridgeport, USA. t.juvet@sabu.edu
authors.forename: Tristan
authors.initials: T
authors.lastname: Juvet
authors.forename: Venkata C
authors.initials: VC
authors.lastname: Gourineni
authors.forename: Sandeep
authors.initials: S
authors.lastname: Ravi
authors.forename: Stuart W
authors.initials: SW
authors.lastname: Zarich
mesh_terms: D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects*; D064420:Drug-Related Side Effects and Adverse Reactions; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis* / Q000628:therapy; D006435:Renal Dialysis; D013015:Sotalol / Q000009:adverse effects; D013148:Spironolactone / Q000009:adverse effects; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects
chemical_list: D000889:Anti-Arrhythmia Agents; D004232:Diuretics; D013148:Spironolactone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D013015:Sotalol