Alappan R, Perazella M A, Buller G K
Yale Primary Care Program, Department of Medicine, St. Mary's Hospital, Waterbury, CT 06706, USA.
Ann Intern Med. 1996 Feb 1;124(3):316-20. doi: 10.7326/0003-4819-124-3-199602010-00006.
To determine the effect of standard-dose trimethoprim-sulfamethoxazole on serum potassium concentration in hospitalized patients.
Prospective chart review.
Community-based teaching hospital.
105 patients with various infections were hospitalized and treated. Eighty patients treated with standard-dose trimethoprim-sulfamethoxazole (trimethoprim, < or = 320 mg/d; sulfamethoxazole, < or = 1600 mg/d) composed the treatment group; 25 patients treated with other antibiotic agents served as the control group.
Serum sodium, potassium, and chloride concentrations; serum carbon dioxide content; anion gap; blood urea nitrogen level; and serum creatinine level.
The serum potassium concentration in the treatment group (mean +/- SD) was 3.89 +/- 0.46 mmol/L (95% CI, 3.79 to 3.99 mmol/L), and it increased by 1.21 mmol/L (CI, 1.09 to 1.32 mmol/L) 4.6 +/- 2.2 days after trimethoprim-sulfamethoxazole therapy was initiated. Blood urea nitrogen levels increased from 7.92 +/- 5.7 mmol/L (CI, 6.67 to 9.16 mmol/L) to 9.2 +/- 5.8 mmol/L (CI, 7.9 to 10.5 mmol/L), and serum creatinine levels increased from 102.5 +/- 49.5 mumol/L (CI, 91.4 to 113.6 mumol/L) to 126.1 +/- 70.7 mumol/L (CI, 110.3 to 141.9 mumol/L). Patients with a serum creatinine level of 106 mumol/L (1.2 mg/dL) or more developed a higher peak potassium concentration (5.37 +/- 0.59 mmol/L [CI, 5.15 to 5.59 mmol/L]) than patients with a serum creatinine level of less than 106 mumol/L (4.95 +/- 0.48 mmol/L [CI, 4.80 to 5.08 mmol/L]). Patients with diabetes had a slightly higher peak potassium concentration (5.14 +/- 0.45 mmol/L [CI, 4.93 to 5.39 mmol/L]) than did patients without diabetes (5.08 +/- 0.59 mmol/L [CI, 4.93 to 5.23 mmol/L]), but the difference was not statistically significant. The serum potassium concentration in the control group was 4.33 +/- 0.45 mmol/L (CI, 4.15 to 4.51 mmol/L), and it decreased nonsignificantly over 5 days of therapy.
Standard-dose trimethoprim-sulfamethoxazole therapy used to treat various infections leads to an increase in serum potassium concentration. A peak serum potassium concentration greater than 5.0 mmol/L developed in 62.5% of patients; severe hyperkalemia (peak serum potassium concentration > or = 5.5 mmol/L) occurred in 21.2% of patients. Patients treated with standard-dose trimethoprim-sulfamethoxazole should be monitored closely for the development of hyperkalemia, especially if they have concurrent renal insufficiency (serum creatinine level > or = 106 mumol/L).
确定标准剂量的甲氧苄啶 - 磺胺甲恶唑对住院患者血清钾浓度的影响。
前瞻性图表回顾。
社区教学医院。
105例患有各种感染的患者住院并接受治疗。80例接受标准剂量甲氧苄啶 - 磺胺甲恶唑治疗的患者（甲氧苄啶，≤320mg/d；磺胺甲恶唑，≤1600mg/d）组成治疗组；25例接受其他抗生素治疗的患者作为对照组。
血清钠、钾、氯浓度；血清二氧化碳含量；阴离子间隙；血尿素氮水平；血清肌酐水平。
治疗组血清钾浓度（均值±标准差）为3.89±0.46mmol/L（95%可信区间，3.79至3.99mmol/L），在开始甲氧苄啶 - 磺胺甲恶唑治疗4.6±2.2天后升高了1.21mmol/L（可信区间，1.09至1.32mmol/L）。血尿素氮水平从7.92±5.7mmol/L（可信区间，6.67至9.16mmol/L）升至9.2±5.8mmol/L（可信区间，7.9至10.5mmol/L），血清肌酐水平从102.5±49.5μmol/L（可信区间，91.4至113.6μmol/L）升至126.1±70.7μmol/L（可信区间，110.3至141.9μmol/L）。血清肌酐水平≥106μmol/L（1.2mg/dL）的患者出现的血钾峰值浓度（5.37±0.59mmol/L[可信区间，5.15至5.59mmol/L]）高于血清肌酐水平<106μmol/L的患者（4.95±0.48mmol/L[可信区间，4.80至5.08mmol/L]）。糖尿病患者的血钾峰值浓度（5.14±0.45mmol/L[可信区间，4.93至5.39mmol/L]）略高于非糖尿病患者（5.08±0.59mmol/L[可信区间，4.93至5.23mmol/L]），但差异无统计学意义。对照组血清钾浓度为4.33±0.45mmol/L（可信区间，4.15至4.51mmol/L），在治疗5天内无显著下降。
用于治疗各种感染的标准剂量甲氧苄啶 - 磺胺甲恶唑治疗会导致血清钾浓度升高。62.5%的患者血钾峰值浓度>5.0mmol/L；21.2%的患者发生严重高钾血症（血钾峰值浓度≥5.5mmol/L）。接受标准剂量甲氧苄啶 - 磺胺甲恶唑治疗的患者应密切监测高钾血症的发生，尤其是在他们并发肾功能不全（血清肌酐水平≥106μmol/L）时。
