分析脂质体两性霉素 B 在儿科患者中的低钾血症副作用。

Analysis of Hypokalemia as a Side Effect of Liposomal Amphotericin in Pediatric Patients.

机构信息

From the Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan.

Department of Pediatrics, St. Marianna University School of Medicine Hospital, Kawasaki, Japan.

出版信息

Pediatr Infect Dis J. 2018 May;37(5):447-450. doi: 10.1097/INF.0000000000001802.

DOI:10.1097/INF.0000000000001802

PMID:28945677

Abstract

BACKGROUND

Liposomal amphotericin (L-AMB) is a widely used broad-spectrum antifungal drug. Although L-AMB demonstrates better safety compared with amphotericin, renal dysfunction and hypokalemia are well-known adverse effects of L-AMB.

METHOD

We analyzed 56 episodes in 40 children and adolescents who received L-AMB therapy to determine risk factors of hypokalemia.

RESULTS

Hypokalemia (<3.0 mEq/L continuously for more than 2 episodes) was observed in 31 of 56 episodes (55.4%). The median onset of hypokalemia was at 10 days on L-AMB (range, 3-54 days), and the median cumulative dose of L-AMB at occurrence of hypokalemia was 25 mg/kg (range, 10-167.5 mg/kg). None of the patients with hypokalemia had solid tumors, and they had significantly higher estimated glomerular filtration rates than those with normokalemia (P = 0.013). Seven of 25 (28.0%) patients in the normokalemia group and 1 of 31 (3.2%) patients in the hypokalemia group had eGFRs of <90 mL/min/1.73 m(2) (P = 0.017).

CONCLUSION

Although the reason for the association between estimated glomerular filtration rates and hypokalemia is unclear, assessing the estimated glomerular filtration rates before L-AMB administration may predict the development of hypokalemia.

摘要

背景

脂质体两性霉素（L-AMB）是一种广泛使用的广谱抗真菌药物。虽然 L-AMB 与两性霉素相比具有更好的安全性，但肾功能障碍和低钾血症是 L-AMB 的已知不良反应。

方法

我们分析了 40 名接受 L-AMB 治疗的儿童和青少年 56 例次中低钾血症的危险因素。

结果

56 例次中有 31 例次（55.4%）出现低钾血症（连续 2 次以上<3.0 mEq/L）。低钾血症的中位发病时间为 L-AMB 治疗后 10 天（范围 3-54 天），发生低钾血症时 L-AMB 的累积剂量中位数为 25mg/kg（范围 10-167.5mg/kg）。发生低钾血症的患儿均无实体瘤，估计肾小球滤过率（eGFR）明显高于血钾正常的患儿（P = 0.013）。血钾正常组 25 例次中有 7 例（28.0%）和低钾血症组 31 例次中有 1 例（3.2%）eGFR <90mL/min/1.73m2（P = 0.017）。