HYPERKALEMIC RENAL TUBULAR-ACIDOSIS INDUCED BY TRIMETHOPRIM SULFAMETHOXAZOLE IN AN AIDS PATIENT/

A patient with the acquired immunodeficiency syndrome (AIDS) and sickl e cell anemia presented to the University of Wisconsin Hospital on two separate occasions with pneumocystis carinii pneumonia (PCP). On both occasions he was treated with high-dose intravenous trimethoprim/sulf amethoxazole (TMP/SMX). Several days into each treatment course he dev eloped hyper kalemia and systemic acidosis consistent with hyperkalemi c renal tubular acidosis (RTA). The abnormalities resolved in the firs t instance with the addition of amphotericin B while continuing TMP/SM X, and in the second upon discontinuation of the TMP/SMX. While an inc reasing number of cases with TMP/SMX-induced hyperkalemia have been re ported, hyperkalemic RTA is an uncommon complication of TMP/SMX therap y, occurring in patients with predisposing factors or acidosis such as aldosterone defects, medullary dysfunction and renal insufficiency.