Witt J M, Koo J M, Danielson B D
Trinity Hospital Pharmacy, Minot, ND 58702, USA.
Ann Pharmacother. 1996 Apr;30(4):347-50. doi: 10.1177/106002809603000404.
To determine the effect of standard-dose trimethoprim/sulfamethoxazole (TMP/SMX) (TMP 160 mg and SMX 800 mg q12h) on the serum potassium concentration.
Retrospective and concurrent study.
A Veterans Affairs Medical Center.
Fifty-three men hospitalized at the Fargo Veterans Affairs Medical Center. Thirty-three patients who received standard-dose TMP/SMX for 3 or more days comprised the study group. Twenty patients who received oral cephradine or amoxicillin for 3 or more days comprised the control group. Patients who received potassium supplements, potassium-sparing diuretics, angiotensin-converting enzyme inhibitors, nonsteroidal antiinflammatory drugs, beta-blockers, heparin, known nephrotoxic agents, patients with a serum creatinine concentration of more than 177 mumol/L, and patients with baseline hyperkalemia (serum potassium concentration > 5.1 mmol/L) were excluded.
The serum potassium concentration in the study group was 4.22 +/- 0.40 mmol/L and increased by 0.31 +/- 0.38 mmol/L at the end of therapy (p < 0.001). Twenty-six patients in the study group (78.8%) had an increase in the serum potassium concentration during TMP/SMX therapy. Fourteen of these patients had follow-up serum potassium concentrations obtained after completion of therapy. The serum potassium concentration returned to baseline in 10 of these patients. The serum creatinine concentration also increased during therapy. However, the correlation between the increase in the serum potassium concentration and the increase in the serum creatinine concentration was weak (Pearson r = 0.29). The serum potassium in the control group was 4.34 mmol/L and remained essentially unchanged during therapy.
Therapy with standard-dose TMP/SMX is associated with a slight increase in the serum potassium concentration. Routine monitoring of the serum potassium concentration in patients who are treated with standard-dose TMP/SMX therapy is unnecessary. However, TMP/SMX should be considered as a possible cause of unexplained hyperkalemia in elderly patients receiving TMP/SMX therapy.
确定标准剂量的甲氧苄啶/磺胺甲恶唑（TMP/SMX）（TMP 160mg及SMX 800mg，每12小时一次）对血清钾浓度的影响。
回顾性和同期研究。
一家退伍军人事务医疗中心。
53名在法戈退伍军人事务医疗中心住院的男性。33名接受标准剂量TMP/SMX治疗3天或更长时间的患者组成研究组。20名接受口服头孢拉定或阿莫西林治疗3天或更长时间的患者组成对照组。排除接受补钾、保钾利尿剂、血管紧张素转换酶抑制剂、非甾体抗炎药、β受体阻滞剂、肝素、已知肾毒性药物的患者，血清肌酐浓度超过177μmol/L的患者，以及基线高钾血症（血清钾浓度>5.1mmol/L）的患者。
研究组血清钾浓度为4.22±0.40mmol/L，治疗结束时升高了0.31±0.38mmol/L（p<0.001）。研究组26名患者（78.8%）在TMP/SMX治疗期间血清钾浓度升高。其中14名患者在治疗结束后进行了随访血清钾浓度检测。这些患者中有10名血清钾浓度恢复到基线水平。治疗期间血清肌酐浓度也升高。然而，血清钾浓度升高与血清肌酐浓度升高之间的相关性较弱（Pearson相关系数r=0.29）。对照组血清钾为4.34mmol/L，治疗期间基本保持不变。
标准剂量TMP/SMX治疗与血清钾浓度略有升高有关。接受标准剂量TMP/SMX治疗的患者无需常规监测血清钾浓度。然而，对于接受TMP/SMX治疗的老年患者，TMP/SMX应被视为不明原因高钾血症的可能原因。
