Posters
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Introduction: Hyperkalemia is a potentially life-threatening complication of several medications, particularly in situations of polypharmacy. Trimethoprim/sulfamethoxazole (TMP-SMX) is a first line antibiotic for outpatient treatment of MRSA for skin and soft tissue infections that can enhance the hyperkalemic effects of spironolactone and Angiotensin receptor inhibitors (ACEI).
Case Presentation: A 53-year-old female with history of HTN, stage 3 CKD, CHF, hypercholesterolemia and DM II, chronic left foot ulcer presented to our local hospital with generalized malaise, severe lower extremity weakness and heaviness of 2 days duration. She normally uses a walker but has had increasing difficulty standing from a seated position. Her medications included: spironolactone, carvedilol, lisinopril, amlodipine, aspirin, atorvastatin, and insulin and had been started on TMP-SMX for the management of an infected chronic ulcer. Physical exam was significant for a blood pressure of 182/87 mm Hg, BMI of 52, lethargy, dry oral mucous membranes, and nonsignificant musculoskeletal examination. The laboratory results revealed significantly elevated potassium levels at 8.6 mmol/L; GFR of 31 and creatinine: 1.79 mg/dL. EKG revealed tall, peaked T-waves with widened QRS complexes in the precordial leads and a right BBB. TMP-SMX, spironolactone and lisinopril were discontinued, and the patient was started on a hyperkalemia treatment protocol. The patient improved rapidly over the next 3 days with resolution of the ECG changes, improved muscle strength and the potassium level was back to normal limits by the time of discharge.
Conclusion: Clinicians and pharmacists should be aware of the enhanced hyperkalemic effects of TMP-SMX, spironolactone and lisinopril and should avoid this combination.
Academic/Professional Position
Medical Student
Mentor/PI Department
Internal Medicine
Recommended Citation
Nwosuocha, Daniel; Masood, Areeb; Abraham, Christian; Sanchez, Vanessa; Peralta, Cesar A.; Montalvo, Alberto E.; and Campo Maldonado, Jose E., "Bactrim, Spironolactone and Lisinopril. Stay Away! A Dangerous Cocktail for Hyperkalemia" (2023). Research Symposium. 25.
https://scholarworks.utrgv.edu/somrs/theme1/posters/25
Included in
Bactrim, Spironolactone and Lisinopril. Stay Away! A Dangerous Cocktail for Hyperkalemia
Introduction: Hyperkalemia is a potentially life-threatening complication of several medications, particularly in situations of polypharmacy. Trimethoprim/sulfamethoxazole (TMP-SMX) is a first line antibiotic for outpatient treatment of MRSA for skin and soft tissue infections that can enhance the hyperkalemic effects of spironolactone and Angiotensin receptor inhibitors (ACEI).
Case Presentation: A 53-year-old female with history of HTN, stage 3 CKD, CHF, hypercholesterolemia and DM II, chronic left foot ulcer presented to our local hospital with generalized malaise, severe lower extremity weakness and heaviness of 2 days duration. She normally uses a walker but has had increasing difficulty standing from a seated position. Her medications included: spironolactone, carvedilol, lisinopril, amlodipine, aspirin, atorvastatin, and insulin and had been started on TMP-SMX for the management of an infected chronic ulcer. Physical exam was significant for a blood pressure of 182/87 mm Hg, BMI of 52, lethargy, dry oral mucous membranes, and nonsignificant musculoskeletal examination. The laboratory results revealed significantly elevated potassium levels at 8.6 mmol/L; GFR of 31 and creatinine: 1.79 mg/dL. EKG revealed tall, peaked T-waves with widened QRS complexes in the precordial leads and a right BBB. TMP-SMX, spironolactone and lisinopril were discontinued, and the patient was started on a hyperkalemia treatment protocol. The patient improved rapidly over the next 3 days with resolution of the ECG changes, improved muscle strength and the potassium level was back to normal limits by the time of discharge.
Conclusion: Clinicians and pharmacists should be aware of the enhanced hyperkalemic effects of TMP-SMX, spironolactone and lisinopril and should avoid this combination.