trimethoprim--sulfamethoxazole-drug-combination and Acidosis

Topics: Acidosis; Aged; Anti-Infective Agents; Anuria; Arthritis, Rheumatoid; Coma; Emergencies; Humans; Hyperkalemia; Hypoglycemia; Kidney Failure, Chronic; Male; Myocardial Ischemia; Pneumocystis Infections; Trimethoprim, Sulfamethoxazole Drug Combination

A 17-year-old male ingested about 20 tablets of propafenone (total 6,000 mg) and 24 tablets of trimethoprim (total 1,920 mg)--sulfamethoxazole (total 9,600 mg) with suicidal intent. Within one hour, he was brought to a hospital with vomiting, nausea, and loss of consciousness, where he developed cyanosis and mild acidosis, and eventually cardiorespiratory arrest, despite bicarbonate, saline infusion, and inotropic support. Fortunately, he was fully resuscitated and ventilated, and sinus rhythm was restored. He was then transported to our center. On admission, his heart rate was regular with 55 beats/min and blood pressure was 70/45 mmHg. The 12-lead electrocardiogram (ECG) showed sinus bradycardia, extreme widening of the QRS complex (260 msec) with a right bundle branch block pattern. Intravenous saline, bicarbonate, and dopamine were administered, and respiration was supported mechanically, which resulted in rapid restoration of sinus rhythm and improvement in hemodynamic parameters and acidosis. A subsequent ECG showed shortening of the QRS duration (230 msec). He was discharged with an appropriate hemodynamic balance on the third day with normal ECG findings.

Topics: Acidosis; Bicarbonates; Cyanosis; Dopamine; Echocardiography, Transesophageal; Electrocardiography; Humans; Male; Middle Aged; Propafenone; Sodium Chloride; Suicide, Attempted; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acidosis; Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Humans; Hydrogen-Ion Concentration; Male; Pneumonia, Pneumocystis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acidosis; Bacterial Infections; Bicarbonates; Breast Feeding; Catheters, Indwelling; Diarrhea, Infantile; Follow-Up Studies; Humans; Infant, Newborn; Intestinal Obstruction; Male; Metronidazole; Milk, Human; Neomycin; Parenteral Nutrition; Ranitidine; Short Bowel Syndrome; Sodium; Sodium Bicarbonate; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vomiting

Digestive features and metabolic acidosis have been observed in patients with Pneumocystis carinii pneumonia treated with intravenous high dose co-trimoxazole.. To evaluate this phenomenon, a retrospective study of 22 patients (group A) and a prospective study of 12 patients (group B) were carried out. Group B patients were investigated following a protocol lasting for the 21 days of treatment.. Metabolic acidosis developed in 23 (67%) of the overall number of study patients, and it was associated with digestive features such as nausea, vomiting and epigastralgia in 12. One patient had digestive features without metabolic acidosis. Metabolic acidosis developed early, between the days 4 and 7 of administration of the drug. The mean value of bicarbonate at the onset of therapy was 24,55 mEq; the mean value in the patients with metabolic acidosis was 16,43 mEq. The overall mean value of base excess at the onset of therapy was -2,39, and it was -8,46 in the patients who developed metabolic acidosis.. As in all patients other causes of metabolic acidosis were ruled out, it became obvious that intravenous co-trimoxazole was directly related to the development of digestive features and metabolic acidosis, which disappeared with bicarbonate administration or with cessation of therapy.

Topics: Acidosis; Adult; Bicarbonates; Digestive System Diseases; Female; Humans; Injections, Intravenous; Male; Pneumonia, Pneumocystis; Prospective Studies; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination