Mori Honami, Kuroda Yutaka, Imamura Shigeki, Toyoda Akira, Yoshida Izumi, Kawakami Masanobu, Tabei Kaoru
Division of General Medicine, Department of Internal Medicine, Jichi Medical School Omiya Medical Center, Saitama.
Intern Med. 2003 Aug;42(8):665-9. doi: 10.2169/internalmedicine.42.665.
High-dose trimethoprim-sulfamethoxazole (TMP-SMX) is known to cause hyperkalemia by blocking amiloride-sensitive sodium (Na) channels in distal nephrons. The purpose of this study was to establish whether the standard dose of TMP-SMX could cause electrolyte disorders.
Serum Na, potassium (K) and creatinine (Cr) levels were examined retrospectively in 53 of 77 patients prescribed TMP-SMX, before and after taking the antibiotic combination.
Electrolyte disorders (Na < 135 mEq/l and/or K > 5.0 mEq/l) were found in 14 of the 53 patients (26.4%) during TMP-SMX treatment. The average dose was 145.7 +/- 24.9 mg/day. The dose of TMP was significantly larger in patients with electrolyte disorders (267.7 +/- 84.2 mg vs. 101.9 +/- 9.38 mg, p = 0.0024). Electrolyte disorders were also seen in 9.1% and 22.2% of patients given the low dose (TMP < 80 mg) or standard dose (TMP 80-120 mg) of TMP-SMX, respectively. Electrolyte disorders were seen in 85.7% of patients with renal dysfunction (Cr > 1.2 mg/dl), compared with 17.5% of patients with normal renal function (p = 0.0008). Logistic regression analysis showed that the dose of TMP and the presence of renal dysfunction increased the incidence of electrolyte disorders with an odds ratio of 2.35 and 80.29, respectively.
Electrolyte disorders, particularly hyperkalemia and hyponatremia can be detected in patients given TMP-SMX. These disorders are more frequent in patients given high doses, but can also be detected after low-dose administration. Renal dysfunction accelerates the incidence of electrolyte disorders induced by TMP-SMX.
已知大剂量甲氧苄啶 - 磺胺甲恶唑（TMP - SMX）可通过阻断远端肾单位中阿米洛利敏感的钠（Na）通道而导致高钾血症。本研究的目的是确定标准剂量的TMP - SMX是否会引起电解质紊乱。
对77例服用TMP - SMX的患者中的53例进行回顾性研究，检测其服用抗生素组合前后的血清钠（Na）、钾（K）和肌酐（Cr）水平。
在53例患者中，有14例（26.4%）在TMP - SMX治疗期间出现电解质紊乱（Na < 135 mEq/l和/或K > 5.0 mEq/l）。平均剂量为145.7±24.9 mg/天。出现电解质紊乱的患者中TMP的剂量显著更高（267.7±84.2 mg对101.9±9.38 mg，p = 0.0024）。给予低剂量（TMP < 80 mg）或标准剂量（TMP 80 - 120 mg）TMP - SMX的患者中，分别有9.1%和22.2%出现电解质紊乱。肾功能不全（Cr > 1.2 mg/dl）患者中85.7%出现电解质紊乱，而肾功能正常患者中这一比例为17.5%（p = 0.0008）。逻辑回归分析表明，TMP剂量和肾功能不全的存在会增加电解质紊乱的发生率，优势比分别为2.35和80.29。
服用TMP - SMX的患者可检测到电解质紊乱，尤其是高钾血症和低钠血症。这些紊乱在高剂量给药的患者中更常见，但低剂量给药后也可检测到。肾功能不全会加速TMP - SMX诱导的电解质紊乱的发生率。
