Trimethoprim-Sulfamethoxazole-Induced Hyperkalemia in a Patient with Normal Renal Function

Abstract

The authors present a case of Trimethoprim-sulfamethoxazole-induced hyperkalemia in a patient with normal renal function. While toxicity of this drug has been reported in patients with renal insufficiency, this case highlights the toxicity associated with normal kidney function. Due to its popularity in the medical field and to the largely unrecognized effect of hyperkalemia, it is important to consider such adverse effects when prescribing TMX-SMX. One must be reminded of the possibility of the development of life-threatening hyperkalemia in relatively healthy patients.

Virgin coconut oil protects against liver damage in albino rats challenged with the anti-folate combination, trimethoprim-sulfamethoxazole

“…TMP-SMX inhibits folate production in bacteria by blocking bacterial dihydrofolic acid reductase, which causes reduced production of purines and subsequently DNA [3]. Earlier, rashes and gastrointestinal distress were believed to be the most frequent side effects of the drug until a reported case of hyperkalemia [4]. Furthermore, researchers have demonstrated the hepatotoxic, nephrotoxic, and genotoxic effects of the antibiotic [5][6][7].…”

Cotrimoxazole‐induced hyperkalemia in renal transplant patient—Case report

“… 3 A study conducted by Rana M Al AdAwi et al about the incidence of cotrimoxazole‐induced hyperkalemia in tertiary care showed 28% regardless of interacting drugs and 33% without interacting drugs. 4 Though hyperkalemia by TMP‐SMX is common in patients with renal insufficiency, it can even occur in patients with normal renal function 5 and with a standard dose. 6 Similarly, More AS et al presented a case of TMP‐SMX induced hyperkalemia in renal transplant.…”

Mechanisms and management of drug-induced hyperkalemia in kidney transplant patients

“…Hyperkalemia is a rare side effect of TMP/SMX in healthy patients, although cases have been reported [31]. The side effect becomes more prominent in patients with an underlying disorder of potassium metabolism, kidney insufficiency, or if drugs known to induce hyperkalemia 1 3 are given concomitantly [31].…”