HYPERKALEMIA WITH RENAL TUBULAR DYSFUNCTION BY SULFAMETHOXAZOLE-TRIMETHOPRIM FOR PNEUMOCYSTIS-CARINII PNEUMONIA IN PATIENTS WITH LYMPHOID MALIGNANCY

Hyperkalaemia with renal tubular dysfunction by oral therapy of sulfam ethoxazole-trimethoprim (co-trimoxazole) is described in 2 elderly Jap anese patients with lymphoid malignancy, who developed Pneumocystis ca rinii pneumonia and improved. A high dose of co-trimoxazole induced hy perkalaemia with the elevation of serum creatinine and blood urea, and increased urinary N-acetyl glucosaminase after several days of the dr ug administration in these patients; one patient became unconscious. D iscontinuation of co-trimoxazole normalized serum potassium level and symptoms. A repeated low dose of the drug induced hyperkalaemia. Befor e the treatment of co-trixomazole, their serum levels of creatinine sh owed upper limits of normal ranges. In the present study, our cases su ggested that patients receiving a high dose of co-trimoxazole should b e evaluated for these potential complications during a course of treat ment, particularly in elderly patients with preexisting renal dysfunct ion.