1443. N-Acetyl Cysteine Coadministration in Prevention of Amphotericin--Induced Electrolytes Imbalances in Children

Abstract

BackgroundAmphotericin B (AmB) can cause electrolyte abnormalities, including hypokalemia, hypomagnesemia, hypernatremia, and metabolic acidosis; and most important, acute renal failure.MethodsWe conducted a randomized prospective cohort study from March 2012 to February 2018 at Hacettepe University Ihsan Doğramacı Children Hospital to children receiving AmB.ResultsA total of 87 patients including 37 patients with NAC and 50 patients without NAC received liposomal amphotericin B during the study period.Serum creatinine, blood urea nitrogen, phosphorus were not different statistically in both groups during the study period. Serum sodium, potassium, calcium, phosphorus, magnesium values taken on third day of AmB treatment were not statistically different in both groups. Mean serum magnesium value was higher in NAC received group on the seventh day of AmB treatment; 1.97 ± 0.33 and 1.69 ± 0.46, respectively, it was statistically significant (P = 0.025). Mean serum magnesium value was also statistically significantly higher in NAC received group on the 14th day of treatment; 1.93 ± 0.20 and 1.72 ± 0.247, respectively, in both groups (P = 0.01). Mean serum sodium values on the 14th day of AmB treatment were also statistically different between 2 groups; 136.7 ± 3.7 and 140.04 ± 5.1, respectively (P = 0.005). Serum sodium values on the 14th day of AmB treatment was in more normal limits in NAC received group. Serum alanine aminotransferase level was significantly lower in NAC received group (P = 0.02). Serum aspartate aminotransferase level was significantly lower in NAC received group (P = 0.007). Nineteen of 37 (51.4%) patients who received NAC concomitantly with AmB and 44 of 50 patients (88%) who received AmB without NAC supplemented with potassium due to hypokalemia (P < 0.001). Two of NAC received 37 patients (5.4%) and 10 of NAC not received 50 patients (20%) died. Mortality was found 2.3 times more in NAC not-received group.ConclusionCo-treatment with oral NAC once daily in children during AmB treatment course was significantly effective in preventing or ameliorating different features of its nephrotoxicity including hypokalemia, hypomagnesemia, and renal potassium as well as magnesium wasting Disclosures All authors: No reported disclosures.