trimethoprim--sulfamethoxazole-drug-combination and Acidosis--Renal-Tubular

A patient with the acquired immunodeficiency syndrome (AIDS) and sickle cell anemia presented to the University of Wisconsin Hospital on two separate occasions with pneumocystis carinii pneumonia (PCP). On both occasions he was treated with high-dose intravenous trimethoprim/sulfamethoxazole (TMP/SMX). Several days into each treatment course he developed hyperkalemia and systemic acidosis consistent with hyperkalemic renal tubular acidosis (RTA). The abnormalities resolved in the first instance with the addition of amphotericin B while continuing TMP/SMX, and in the second upon discontinuation of the TMP/SMX. While an increasing number of cases with TMP/SMX-induced hyperkalemia have been reported, hyperkalemic RTA is an uncommon complication of TMP/SMX therapy, occurring in patients with predisposing factors for acidosis such as aldosterone defects, medullary dysfunction and renal insufficiency.

Topics: Acidosis, Renal Tubular; Adult; AIDS-Related Opportunistic Infections; Anemia, Sickle Cell; Anti-Infective Agents; Drug Therapy, Combination; HIV-1; Humans; Hyperkalemia; Male; Pneumonia, Pneumocystis; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acidosis, Renal Tubular; Anti-Infective Agents, Urinary; Electrochemistry; Escherichia coli Infections; Humans; Hydrogen-Ion Concentration; Hyperkalemia; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acidosis, Renal Tubular; Adult; AIDS-Related Opportunistic Infections; Humans; Male; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acidosis, Renal Tubular; Acquired Immunodeficiency Syndrome; Adult; Humans; Male; Opportunistic Infections; Pentamidine; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

The antibiotics trimethoprim (TMP) and sulfamethoxazole (SMZ), when used in combination, can cause metabolic acidosis, renal bicarbonate wasting, and growth failure. Retrospective review of repeated random serum chemistries from 10 children receiving TMP-SMZ and maintenance chemotherapy for acute lymphoid leukemia revealed low serum bicarbonate (P = .0002) and elevated serum chloride (P less than .0005) concentrations. These values normalized after all medications were discontinued. Prospective study of 8 children receiving TMP-SMZ and chemotherapy for acute lymphoid leukemia revealed lower serum bicarbonate concentrations and higher urine pH following a dose of TMP-SMZ than paired values obtained more than 3 days after a dose. Four children (50%) met serum bicarbonate and urinary pH criteria for the diagnosis of renal tubular acidosis soon after a dose of TMP-SMZ. The occurrence of TMP-SMZ-induced renal tubular acidosis has implications for the acid-base balance of children receiving TMP-SMZ on a long-term basis.

Topics: Acidosis, Renal Tubular; Adolescent; Bicarbonates; Child; Child, Preschool; Chlorides; Female; Humans; Hydrogen-Ion Concentration; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

A child was evaluated for growth failure at the University of California, San Diego. On two occasions the patient had renal bicarbonate wasting, acidosis, and growth failure associated with trimethoprim/sulfamethoxazole (TMP/SMZ) administration. On both occasions, the acidosis resolved and the growth rate normalized following a period without receiving TMP/SMZ. Renal tubular acidosis and growth failure may occur as a result of TMP/SMZ therapy in children.

Topics: Acidosis, Renal Tubular; Female; Growth Disorders; Humans; Infant; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination