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Analysis of Hypokalemia as a Side Effect of Liposomal Amphotericin in Pediatric Patients.

Kobayashi, Ryoji MD; Keino, Dai MD; Hori, Daiki MD; Sano, Hirozumi MD; Suzuki, Daisuke MD; Kishimoto, Kenji MD; Kobayashi, Kunihiko MD
Pediatric Infectious Disease Journal: Post Acceptance: September 21, 2017
doi: 10.1097/INF.0000000000001802
Antimicrobial Reports: PDF Only

BACKGROUND: Liposomal amphotericin (L-AMB) is a widely used broad-spectrum anti-fungal drug. Although L-AMB demonstrates better safety compared with amphotericin, renal dysfunction and hypokalemia are well-known adverse effects of L-AMB.

METHOD: We analyzed 56 episodes in 40 children and adolescents who received L-AMB therapy to determine risk factors of hypokalemia.

RESULTS: Hypokalemia (<3.0 mEq/L continuously for more than two episodes) was observed in 31 out of 56 episodes (55.4%). The median onset of hypokalemia was at 10 days on L-AMB (range, 3-54 days), and the median cumulative dose of L-AMB at occurrence of hypokalemia was 25 mg/kg (range, 10-167.5 mg/kg). None of the patients with hypokalemia had solid tumors, and they had significantly higher estimated glomerular filtration rates (eGFR) than those with normokalemia (p=0.013). Seven of 25 (28.0%) patients in the normokalemia group and 1 of 31 (3.2%) patients in the hypokalemia group had eGFRs of <90 mL/min/1.73 m2 (p=0.017).

CONCLUSION: Although the reason for the association between eGFR and hypokalemia is unclear, assessing the eGFR before L-AMB administration may predict the development of hypokalemia

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