Sheehan M T, Wen S F
Department of Medicine, University of Wisconsin Center for Health Sciences, Madison, USA.
Clin Nephrol. 1998 Sep;50(3):188-93.
A patient with the acquired immunodeficiency syndrome (AIDS) and sickle cell anemia presented to the University of Wisconsin Hospital on two separate occasions with pneumocystis carinii pneumonia (PCP). On both occasions he was treated with high-dose intravenous trimethoprim/sulfamethoxazole (TMP/SMX). Several days into each treatment course he developed hyperkalemia and systemic acidosis consistent with hyperkalemic renal tubular acidosis (RTA). The abnormalities resolved in the first instance with the addition of amphotericin B while continuing TMP/SMX, and in the second upon discontinuation of the TMP/SMX. While an increasing number of cases with TMP/SMX-induced hyperkalemia have been reported, hyperkalemic RTA is an uncommon complication of TMP/SMX therapy, occurring in patients with predisposing factors for acidosis such as aldosterone defects, medullary dysfunction and renal insufficiency.
一名患有获得性免疫缺陷综合征（艾滋病）和镰状细胞贫血的患者，两次因卡氏肺孢子虫肺炎（PCP）就诊于威斯康星大学医院。两次就诊时，他均接受了大剂量静脉注射甲氧苄啶/磺胺甲恶唑（TMP/SMX）治疗。在每个治疗疗程的数天后，他出现了高钾血症和全身酸中毒，符合高钾性肾小管酸中毒（RTA）。在第一种情况下，在继续使用TMP/SMX的同时加用两性霉素B后异常情况得到缓解，在第二种情况下，停用TMP/SMX后异常情况得到缓解。虽然已有越来越多关于TMP/SMX诱导的高钾血症病例的报道，但高钾性RTA是TMP/SMX治疗罕见的并发症，发生于存在酸中毒易感因素的患者，如醛固酮缺陷、髓质功能障碍和肾功能不全。
