Emtricitabine/tenofovir disoproxil fumarate
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Severe hypokalaemia: case report A 51-year-old HIV positive man developed severe hypokalaemia while receiving antiretroviral therapy with emtricitabine/tenofovir disoproxil fumarate [duration of treatment to reaction onset not stated]. The man started receiving daily emtricitabine 200mg/ tenofovir disoproxil fumarate 300mg, ritonavir and fosamprenavir. He was eventually hospitalised with a 2-month history of abdominal pain, fever and severe weight loss. On admission, he was cachexic, had a BP of 90/50mm Hg and bilateral rhochi were revealed by chest auscultation. Laboratory investigations showed discrete pancytopenia, and potassium, sodium and creatinine levels of 3.6 mEq/L, 139 mEq/L and 0.8 mg/dL, respectively. He was noted to have pneumococcus antigens and a Candida albicans infection, and sepsis was suspected. He started receiving piperacillin/ tazobactam 4g three times daily and fluconazole 100mg twice daily. Antibiotics were eventually withdrawn and, 48 hours later, he had a potassium level of 2 mEq/L. A venous blood gas investigations showed a pH of 7.45, a pCO2 of 41mm Hg and a bicarbonate level of 28 mmol/L; urinalysis revealed potassium and sodium levels of 15 mEq/L and 63 mEq/L, respectively. He had a sinus rhythm at 64 beat/min on ECG, with a prolonged QTc interval of 466ms, flattened T waves and prominent U waves. Emtricitabine/tenofovir disoproxil fumarate was withdrawn and the man started receiving potassium supplements. After 72 hours, his potassium levels had normalised. Author comment: In our case, we cannot rule out the possibility that treatment with piperacillin/tazobactam and fluconazole aggravated the patient’s hypokalaemia. . . It must be noted that the patient’s potassium concentrations were already at the lower limit upon admission, which tends to favour the implication of tenofovir in the triggering of hypokalaemia. Castrillo-Bustamante C, et al. Severe hypokalemia and tenofovir. Enfermedades Infecciosas Y Microbiologia Clinica 26: 317-318, No. 5, May 2008 [Spanish; 801111645 summarised from a translation.] - Spain
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Reactions 28 Jun 2008 No. 1208
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