Abstract
Abstract High-dose trimethoprim-sulfamethaxazole is the drug of choice for treatment of severe Pneumocystis jiroveci pneumonia (PJP) with the caveat that at higher doses, serious adverse events occur more frequently. A lethal complication is hyperkalemia which often mandates premature discontinuation of therapy despite lower efficacy of second-line agents. We report a case of a patient with severe PJP causing respiratory failure treated with high-dose trimethoprim-sulfamethaxazole who experienced hyperkalemia, which was successfully managed with a combination of fludrocortisone and furosemide allowing completion of antibiotic course. Administration of fludrocortisone and furosemide may enable practitioners to effectively address trimethoprim-induced hyperkalemia in critically ill patients with PJP. We speculate that exogenous administration of fludrocortisone may promote transcription of ENaC-amiloride sensitive epithelial sodium channels, which is unaffected by circulating trimethoprim allowing for kaliuresis to be restored. The addition of furosemide increases sodium load, further promoting potassium excretion.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have