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Minerva Medica 2020 Jul 21

DOI: 10.23736/S0026-4806.20.06660-4


language: English

Trimethoprim-associated electrolyte and acid-base abnormalities: a review

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

1 Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; 2 Department of Internal Medicine, Ospedale La Carità, Ente Ospedaliero Cantonale, Locarno, Switzerland; 3 Department of Internal Medicine, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; 4 Università della Svizzera Italiana, Lugano, Switzerland; 5 Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, Lausanne, Switzerland; 6 Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland; 7 Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 8 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 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, co-medicated 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; Acide-base

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