Compound sulfamethoxazole-induced renal tubular acidosis in a patient with anti-synthetase syndrome
10.3760/cma.j.cn114015-20240219-00096
- VernacularTitle:复方磺胺甲噁唑致抗合成酶综合征患者肾小管性酸中毒
- Author:
Xueying CHEN
1
;
Lingyan YU
1
;
Haibin DAI
1
Author Information
1. 浙江大学医学院附属第二医院药剂科，杭州 310051
- Publication Type:Journal Article
- Keywords:
Acidosis, renal tubular;
Sulfamethoxazole;
Trimethoprim;
Hyperkalemia;
Pneumocystosis jirovecii;
Anti-synthetase syndrome
- From:
Adverse Drug Reactions Journal
2025;27(2):122-125
- CountryChina
- Language:Chinese
-
Abstract:
A 58-year-old female patient with anti-synthetase syndrome received compound sulfamethoxazole [containing trimethoprim (TMP) 80 mg and sulfamethoxazole (SMZ) 0.4 g, SMZ-TMP] 3 tablets thrice daily orally for the treatment of Pneumocystis jirovecii pneumonia. Before medication, the patient′s blood potassium was 3.3 mmol/L and blood chlorine was 116 mmol/L. Three days after SMZ-TMP treatment, the patient′s blood potassium was 5.7 mmol/L, blood chlorine was 114 mmol/L, blood pH was 7.3, urine pH was <5.5, blood chlorine was 114 mmol/L, and bicarbonate was 15 mmol/L. Hyperkalemia type renal tubular acidosis due to SMZ-TMP was considered. The dosage of SMZ-TMP was reduced to 2 tablets once daily orally. After 1 day of diuretic and potassium excretion treatments, the patient′s blood potassium levels returned to normal; after 2 days of the treatments, her blood chlorine was 109 mmol/L and bicarbonate was 17 mmol/L; after 3 days of the treatments, her chest CT showed emphysema in the neck and mediastinum. The dose of SMZ-TMP was changed to 3 tablets thrice daily orally, and at the same time intravenous infusion of ganciclovir 0.3 g twice daily was given. And again, her blood potassium increased and blood pH decreased. Sodium bicarbonate 1 g thrice daily orally was given to correct the acidosis. After adding SMZ-TMP for 2 days, SMZ-TMP dosage was reduced to 2 tablets once daily orally again. Seven days later, the patient′s vital signs were stable, her mediastinal emphysema was significantly improved, her blood potassium was 4.7 mmol/L, and blood pH was 7.4.
