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Minerva Medica 2021 August;112(4):500-5

DOI: 10.23736/S0026-4806.20.06660-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Trimethoprim-associated electrolyte and acid-base abnormalities

Erica MEMOLI 1, 2, Pietro B. FARÉ 3, 4, Pietro CAMOZZI 2, 5, Giacomo D. SIMONETTI 1, 2, 6, Mario G. BIANCHETTI 6, Sebastiano A. LAVA 7, 8 , Gregorio P. MILANI 1, 2, 9, 10

1 Pediatric Institute of Southern Switzerland, San Giovanni Hospital, Bellinzona, Switzerland; 2 Ente Ospedaliero Cantonale, Bellinzona, Switzerland; 3 Department of Internal Medicine, La Carità Hospital, Locarno, Switzerland; 4 Ente Ospedaliero Cantonale, Locarno, Switzerland; 5 Department of Internal Medicine, San Giovanni Hospital, Bellinzona, Switzerland; 6 Università della Svizzera Italiana (USI), Lugano, Switzerland; 7 Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland; 8 Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Lugano, Switzerland; 9 Unit of Pediatrics, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 10 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy



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.


KEY WORDS: Trimethoprim; Electrolytes; Systematic review

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