Cefalexin/sodium bicarbonate
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Hypernatremia and acute interstitial nephritis with assoiated complications: case report A 34-year-old woman developed acute interstitial nephritis, hypokalaemic periodic paralysis, renal tubular injury and renal tubular acidosis while receiving cefalexin for upper respiratory tract infections, and hypernatraemia while receiving sodium bicarbonate for renal tubular acidosis. The woman was admitted with a 24 hour history of inability to move limbs. Her paresis was acute in onset, rapidly progressive in upward direction with complete paralysis of all four limbs within 24 hours. Anamnesis revealed that she had a history of upper respiratory tract infection. She had received oral cefalexin [cephalexin] 500mg two times a day for past 5 days. On current admission, her condition further deteriorated and she required mechanical ventilation and intubation. Based on arterial blood gas analysis, she was diagnosed with renal tubular acidosis. Additionally, hypokalaemia was also noted. Consequently, the woman was treated with sodium bicarbonate infusion [dosage not stated] and potassium chloride, along with piperacillin/tazobactam and other unspecified drugs for presumed septic shock (differential diagnosis). Over the following 48 hours, she further developed severe hypernatraemia along with hypokalaemia and deranged renal parameters. A diagnosis of hypokalaemic periodic paralysis secondary to cefalexin-induced acute interstitial nephritis, renal tubular injury and renal tubular acidosis was made. Her hypernatraemia was attributed to sodium bicarbonate. she was started on glucose [dextrose] for the correction of hypernatraemia. Over the following 3 days, normalisation of hypernatremia and hypokalaemia was noted. Improvement of limb paresis and respiratory drive was also observed. Subsequently, she was weaned off from mechanical ventilation support and extubated. Her laboratory parameters improved, and she gained full power in all four limbs. Kumar R, et al. A rare case of cephalexin-induced acute interstitial nephritis with hypokalemic periodic paralysis. Indian Journal of Pharmacology 52: 210-212, No. 3, Jun 803517247 2020. Available from: URL: http://doi.org/10.4103/ijp.IJP_532_19
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Reactions 28 Nov 2020 No. 1832
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