Drug-Induced Hyperkalemia: Case Presentation and Discussion James D. Coyle, Pharm.D. Winter, 2002.
-
Upload
rosalind-strickland -
Category
Documents
-
view
217 -
download
0
Transcript of Drug-Induced Hyperkalemia: Case Presentation and Discussion James D. Coyle, Pharm.D. Winter, 2002.
Drug-Induced Hyperkalemia:Case Presentation and Discussion
James D. Coyle, Pharm.D.Winter, 2002
Case Series – Drug-Induced Hyperkalemia (1)
• Series of 5 patients (3 M, 2 F), 53–81 yoa
• All taking an ACE-inhibitor, to which amiloride HCl/hydrochlorothiazide was added
• Ann Emerg Med 1997;30:612-615.
Case Series – Drug-Induced Hyperkalemia (2)
Case No.
Age/Sex
PMH Symptoms
1 53 M DM, HTN ½ day weakness, numbness in limbs; abrupt onset VF in ED
2 81 M DM, HTN, gouty arthritis, CKD
Dizziness, nausea, vomiting, slow pulse X several hours (HR 35)
3 70 F DM, HTN, CHF, CKD
Progressive disorientation, confusion over 3 days; slow, irregular pulse (HR 55)
4 66 F DM, HTN, gouty arthritis, CKD
Generalized weakness X 3 days, abdominal pain; collapsed suddenly in ED
5 55 M DM, HTN, CHF Generalized weakness X 3 days
Case Series – Drug-Induced Hyperkalemia (3)
Case No.
Medications Na Kbefore
Kafter
Cr
1 Enalapril (20 mg BID x 2 mos);Amil/HCTZ (1 tab QD x 16 days)
123 3.3 9.4 1.6
2 Enalapril (10 mg QD x 7 wks, then 20 mg x 8 days); amil/HCTZ (1 tab QD x 8 days)
133 4.1 9.9 2.7
3 Enalapril (5 mg QD x 1 mo); amil/HCTZ (1 tab QD x 15 days)
131 4.0 10.4 2.5
4 Enalapril (20 mg QD x 1 mo); amil/HCTZ (1/2 tab QD x 15 days)
129 6.7 11 2.4
5 Captopril (12.5 mg TID, increased to 25 mg TID x 8 days); amil/HCTZ (1 tab QD x 8 days)
124 2.0 6.8 1.2
Case Series – Drug-Induced Hyperkalemia (4)
Case No.
Treatment Outcome
1 CaCl2, NaHCO3, dextrose with insulin Death
2 Discontinued enalapril and amil/HCTZ Recovery
3 Emergency hemodialysis Recovery
4 External pacemaker, aggressive resuscitation
Death
5 Discontinued captopril and amil/HCTZ Recovery
Case Series – Drug-Induced Hyperkalemia (5)
Case No.
ACE-I +Amil/HCTZ
Cr >2.0
MetabolicAcidosis
NSAIDs Rhabdo-myolysis
1 + - + - -
2 + + ND + -
3 + + + - -
4 + + - + -
5 + - - - -
Summary
• Common characteristics and tx of patients with severe, symptomatic hyperkalemia
• Absence of absolute relationship between serum K and symptom severity
• Potential hazards of using two (or more) drugs that can increase K concentrations
• Characteristics of patients requiring particularly careful monitoring