LETTER
Hyperkalemia and Trimethoprim-Sulfamethoxazole
Robert Joseph Thomas, MD
1 November 1996 | Volume 125 Issue 9 | Pages 778-779
TO THE EDITOR:
The recent study by Alappan and colleagues [1] associates the use of standard-dose trimethoprim-sulfamethoxazole with hyperkalemia. Serum potassium levels greater than 5.5 mmol/L would, at minimum, require close monitoring, if not treatment, and their occurrence in 17 of 105 patients is of concern. I recently described a case of severe hyperkalemia (potassium level, 7.0 to 7.4 mmol/L) and renal failure (creatinine level, 292 µmol/L) that developed in a 74-year-old man when trimethoprim, used to treat pyelonephritis, was added to a stable regimen of quinapril for hypertension [2]. The biochemical abnormalities resolved over 36 hours after discontinuation of therapy.
Although the patients and controls in the study by Alappan and colleagues did not differ with respect to use of other drugs known to cause hyperkalemia, it would be of interest to know whether patients who had the most severe hyperkalemia were also being treated with angiotensin-converting enzyme inhibitors. Inhibition of converting enzyme and the ability of trimethoprim to inhibit proximal tubular secretion of creatinine may result in substantial elevations of creatinine level and would certainly represent a concern in the hospitalized patient.
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Author and Article Information
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Alvin C. York Veterans Affairs Medical Center Murfreesboro, TN 37129.
1. Alappan R, Perazella MA, Buller GK. Hyperkalemia in hospitalized patients treated with trimethoprim-sulfamethoxazole. Ann Intern Med. 1996; 124:316-20.
2. Thomas RJ. Severe hyperkalemia with trimethoprim-quinapril. Ann Pharmacother. [In press].
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