Barton C H, Pahl M, Vaziri N D, Cesario T
Am J Med. 1984 Sep;77(3):471-4. doi: 10.1016/0002-9343(84)90106-2.
The effect of amphotericin B on magnesium metabolism was studied in 10 patients (aged 30 to 68 years) with systemic fungal infections. Renal magnesium wasting resulting in mild to moderate hypomagnesemia was demonstrated by the second week of therapy following relatively small cumulative dosages of amphotericin B (208 +/- 40 mg). The lowest serum levels and largest fractional excretions of magnesium were observed by the fourth week of therapy after cumulative dosages of 510 +/- 118 mg. A plateauing of the renal magnesium wasting is suggested, as there were no further increases or reductions in fractional magnesium excretion and serum magnesium level, respectively, despite continued amphotericin B administration. Reversibility of the magnesium wasting is indicated by data in three of the patients approximately one year following discontinuation of amphotericin B therapy, in whom the serum magnesium level and fractional magnesium excretion had returned to pretreatment baseline values. Although the available data do not allow precise localization of this defect, increased urinary excretion of magnesium despite its reduced filtered load suggests a tubular defect in magnesium reabsorption. Therefore, routine monitoring of the serum magnesium level during treatment with amphotericin B is recommended.
对10例（年龄30至68岁）全身性真菌感染患者研究了两性霉素B对镁代谢的影响。在两性霉素B累积剂量相对较小（208±40mg）后的治疗第二周，就出现了导致轻度至中度低镁血症的肾脏镁流失。在累积剂量达510±118mg后的治疗第四周，观察到镁的最低血清水平和最大排泄分数。尽管继续给予两性霉素B，但分别未再出现镁排泄分数和血清镁水平的进一步升高或降低，提示肾脏镁流失趋于平稳。在停用两性霉素B治疗约一年后，3例患者的数据表明镁流失具有可逆性，此时他们的血清镁水平和镁排泄分数已恢复至治疗前的基线值。尽管现有数据无法精确确定该缺陷的部位，但尽管滤过负荷降低，镁的尿排泄仍增加，提示存在肾小管镁重吸收缺陷。因此，建议在两性霉素B治疗期间常规监测血清镁水平。
