DRUG POINTS:Hyperkalaemia and non-oliguric renal failure associated with trimethoprim

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Abstract
On admission her serum urea and electrolyte concentrations were normal. Four days later they were deranged: potassium concentration was 7.0 mmol/l, urea concentration 16.0 mmol/l, serum creatinine concentration 225 μmol/l. Arterial blood gases showed mild metabolic acidosis. An electrocardiogram appeared normal. All drugs were stopped and standard measures taken to lower serum potassium concentration. Trimethoprim was replaced by ampicillin in reduced dose. Urine output was 1.5 1/day and kidneys were of normal size on ultrasonography. Seventy two hours later potassium concentration was 4.3 mmol/l, urea concentration 8.5 mmol/l, and serum creatinine concentration 85 μmol/l. Mesalazine and diphenoxylate were not given again, and she was discharged taking prednisolone and diclofenac. Her renal function remains normal.

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