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Memoli E, Faré PB, Camozzi P, Simonetti GD, Bianchetti MG, Lava SA, Milani GP. Trimethoprim-associated electrolyte and acid-base abnormalities. Minerva Med 2020; 112:500-505. [PMID: 32697061 DOI: 10.23736/s0026-4806.20.06660-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The antimicrobial trimethoprim is structurally related to potassium-sparing diuretics and may consequently lead to derangements in electrolyte and acid-base balance. Since no report so far analyzed the literature documenting individual cases with electrolyte and acid-base derangements induced by trimethoprim, a systematic review was carried out. EVIDENCE ACQUISITION We retained 53 reports documenting 68 cases (42 males and 26 females 23 to 96 years of age) of electrolyte or acid-base derangements occurring on trimethoprim for about 5 days. EVIDENCE SYNTHESIS One hundred five electrolyte imbalances were detected in the 68 patients: hyperkalemia (>5.0 mmol/L) in 62 (91%), hyponatremia (<135 mmol/L) in 29 (43%) and metabolic acidosis (pH<7.38 and bicarbonate <19 mmol/L) in 14 (21%) cases. Following possible predisposing factors for electrolyte and acid-base abnormalities were found in 54 (79%) patients: high-dose trimethoprim, comedication with drugs that have been associated with electrolyte and acid-base derangements, preexisting kidney disease, age ≥80 years and diabetes mellitus. CONCLUSIONS High-dose trimethoprim, comedicated with drugs that have been associated with electrolyte and acid-base derangements, poor kidney function, age ≥80 years and diabetes mellitus predispose to trimethoprim-associated electrolyte and acid-base abnormalities. Clinicians must recognize patients at risk, possibly avoid drug combinations that may worsen the problem and monitor the laboratory values.
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Affiliation(s)
- Erica Memoli
- Pediatric Institute of Southern Switzerland, San Giovanni Hospital, Bellinzona, Switzerland.,Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Pietro B Faré
- Department of Internal Medicine, La Carità Hospital, Locarno, Switzerland.,Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Pietro Camozzi
- Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Department of Internal Medicine, San Giovanni Hospital, Bellinzona, Switzerland
| | - Giacomo D Simonetti
- Pediatric Institute of Southern Switzerland, San Giovanni Hospital, Bellinzona, Switzerland.,Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Università della Svizzera Italiana (USI), Lugano, Switzerland
| | | | - Sebastiano A Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland - .,Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Institute of Southern Switzerland, San Giovanni Hospital, Bellinzona, Switzerland.,Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Unit of Pediatrics, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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