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Scoglio M, Bronz G, Rinoldi PO, Faré PB, Betti C, Bianchetti MG, Simonetti GD, Gennaro V, Renzi S, Lava SAG, Milani GP. Electrolyte and Acid-Base Disorders Triggered by Aminoglycoside or Colistin Therapy: A Systematic Review. Antibiotics (Basel) 2021; 10:antibiotics10020140. [PMID: 33535401 PMCID: PMC7912654 DOI: 10.3390/antibiotics10020140] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
Aminoglycoside or colistin therapy may alter the renal tubular function without decreasing the glomerular filtration rate. This association has never been extensively investigated. We conducted a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Databases searched included United States National Library of Medicine, Excerpta Medica, and Web of Science. For the final analysis, we evaluated 46 reports, published after 1960, describing 82 cases. A total of 286 electrolyte and acid-base disorders were reported. Hypomagnesemia, hypokalemia, and hypocalcemia were reported in more than three quarter of cases. Further disorders were, in decreasing order of frequency, metabolic alkalosis, hyponatremia, hypophosphatemia, hypouricemia, hypernatremia, and metabolic acidosis. Six electrolyte and acid-base disorders were reported in seven cases, five in 12 cases, four in 16 cases, three in 31 cases, two in 11 cases, and one in five cases. Laboratory features consistent with a loop of Henle/distal tubular dysfunction were noted in 56 (68%), with a proximal tubular dysfunction in three (3.7%), and with a mixed dysfunction in five (6.1%) cases. The laboratory abnormality was unclassified in the remaining 18 (22%) cases. Treatment with aminoglycosides or colistin may trigger a proximal tubular or, more frequently, a loop of Henle/distal tubular dysfunction.
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Affiliation(s)
- Martin Scoglio
- Faculty of Biomedicine, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (G.B.); (P.O.R.); (C.B.); (M.G.B.); (G.D.S.); (V.G.)
- Correspondence:
| | - Gabriel Bronz
- Faculty of Biomedicine, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (G.B.); (P.O.R.); (C.B.); (M.G.B.); (G.D.S.); (V.G.)
| | - Pietro O. Rinoldi
- Faculty of Biomedicine, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (G.B.); (P.O.R.); (C.B.); (M.G.B.); (G.D.S.); (V.G.)
- Department of Pediatrics, Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
| | - Pietro B. Faré
- Department of Internal Medicine, Ospedale La Carità, Ente Ospedaliero Cantonale, 6600 Locarno, Switzerland;
| | - Céline Betti
- Faculty of Biomedicine, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (G.B.); (P.O.R.); (C.B.); (M.G.B.); (G.D.S.); (V.G.)
- Department of Pediatrics, Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
| | - Mario G. Bianchetti
- Faculty of Biomedicine, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (G.B.); (P.O.R.); (C.B.); (M.G.B.); (G.D.S.); (V.G.)
| | - Giacomo D. Simonetti
- Faculty of Biomedicine, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (G.B.); (P.O.R.); (C.B.); (M.G.B.); (G.D.S.); (V.G.)
- Department of Pediatrics, Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
| | - Viola Gennaro
- Faculty of Biomedicine, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (G.B.); (P.O.R.); (C.B.); (M.G.B.); (G.D.S.); (V.G.)
| | - Samuele Renzi
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Sebastiano A. G. Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, 1011 Lausanne, Switzerland;
| | - Gregorio P. Milani
- Department of Pediatrics, Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
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Abstract
Metabolic alkalosis defined by the increase of both plasma HCO3- level (>26 mmol/L) and blood arterial pH (>7.43) is quite frequent and usually accompanied by hypokalemia. Its pathogenesis requires both the generation of alkalosis and its maintenance. Generation may be due to excessive hydrogen ion loss by the gastrointestinal tract (e.g. vomiting) or by the kidney (e.g. use of loop diuretics) or may be due to exogenous base gain. Maintenance reflects the inability of the kidney to excrete the excess of bicarbonate because of hypovolemia, chloride depletion, hypokalemia, hyperaldosteronism, renal failure or a combination of these factors. The evaluation of volemic status and measurement of urinary Cl- and plasma levels of renin and aldosterone are crucial to identify the cause(s) of metabolic alkalosis. The cornerstone of treatment is the correction of existing depletions and the prevention of further losses. In vomiting-induced chloride depletion alkalosis, infusion of potassium chloride restores the excretion of bicarbonate by the kidney.
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Affiliation(s)
- Valentine Gillion
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Michel Jadoul
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Olivier Devuyst
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Jean-Michel Pochet
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Bicarbonate in cystic fibrosis. J Cyst Fibros 2017; 16:653-662. [PMID: 28732801 DOI: 10.1016/j.jcf.2017.06.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cystic fibrosis (CF, mucoviscidosis) is caused by mutations in the gene encoding CF transmembrane conductance regulator (CFTR), which is a chloride and bicarbonate channel necessary for fluid secretion and extracellular alkalization. For a long time, research concentrated on abnormal Cl- and Na+ transport, but neglected bicarbonate as a crucial factor in CF. METHODS The present short review reports early findings as well as recent insights into the role of CFTR for bicarbonate transport and its defects in CF. RESULTS The available data indicate impaired bicarbonate transport not only in pancreas, intestine, airways, and reproductive organs, but also in salivary glands, sweat duct and renal tubular epithelial cells. Defective bicarbonate transport is closely related to the impaired mucus properties and mucus blocking in secretory organs of CF patients, causing the life threatening lung disease. CONCLUSIONS Apart from the devastating lung disease, abrogated bicarbonate transport also leads to many other organ dysfunctions, which are outlined in the present review.
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Scurati-Manzoni E, Fossali EF, Agostoni C, Riva E, Simonetti GD, Zanolari-Calderari M, Bianchetti MG, Lava SAG. Electrolyte abnormalities in cystic fibrosis: systematic review of the literature. Pediatr Nephrol 2014; 29:1015-23. [PMID: 24326787 DOI: 10.1007/s00467-013-2712-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/12/2013] [Accepted: 11/18/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cystic fibrosis per se can sometimes lead to hyponatremia, hypokalemia, hypochloremia or hyperbicarbonatemia. This tendency was first documented 60 years ago and has subsequently been confirmed in single case reports or small case series, most of which were retrospective. However, this issue has not been addressed analytically. We have therefore systematically reviewed and analyzed the available literature on this subject. METHODS This was a systematic review of the literature. RESULTS The reports included in this review cover 172 subacute and 90 chronic cases of electrolyte imbalances in patients with cystic fibrosis. The male:female ratio was 1.57. Electrolyte abnormalities were mostly associated with clinically inapparent fluid volume depletion, mainly affected patients aged ≤2.5 years, frequently tended to recur and often were found before the diagnosis of cystic fibrosis was established. Subacute presentation often included an history of heat exposure, vomiting, excessive sweating and pulmonary infection. History of chronic presentation, in contrast, was often inconspicuous. The tendency to hypochloremia, hypokalemia and metabolic alkalosis was similar between subacute and chronic patients, with hyponatremia being more pronounced (P < 0.02) in subacute compared to chronic presentations. Subacute cases were treated parenterally; chronic ones were usually managed with oral salt supplementation. Retention of urea and creatinine was documented in 38 % of subacute cases. CONCLUSIONS The findings of our review suggest that physicians should be aware that electrolyte abnormalities can occur both as a presenting and a recurring feature of cystic fibrosis.
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Affiliation(s)
- Elisabetta Scurati-Manzoni
- Pediatric Emergency Unit, De Marchi Hospital, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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