Amikacin-Induced Bartter-Like Syndrome, Profound Hyponatremia, and Acute Kidney Injury: A Case Report
Kwannate Intarawongchot¹, Kittrawee Kritmetapak¹
Affiliation : ¹ Division of Nephrology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Amikacin is a commonly used aminoglycoside antibiotic for the treatment of severe gram-negative bacterial infections, infective endocarditis, and is also employed as a second-line medication for tuberculosis. Potential side effects of amikacin include nephrotoxicity and ototoxicity, which may occur in high-risk patients, including those on prolonged high-dose therapy, the elderly, and individuals with pre-existing kidney disease or hypovolemia. In addition to acute tubular necrosis, amikacin may cause Bartter-like syndrome, manifested with polyuria, hyponatremia, hypokalemia, hypochloremic metabolic alkalosis, hypocalcemia, hypercalciuria, and hypomagnesemia. We report a case of an elderly woman who developed non-oliguric acute kidney injury and Bartter-like syndrome, with life-threatening hyponatremia (Na+ 104 mEq/L) and hypokalemia (K+ 1.5 mEq/L), after a 4-week amikacin therapy with a cumulative dose of 28 g. The patient required cautious intravenous fluid and electrolyte replacement, and kidney function recovered approximately 6 weeks after discontinuing amikacin and providing supportive care. In summary, prudent prescribing, close monitoring of kidney function and electrolytes, and prompt cessation at signs of aminoglycoside nephrotoxicity may aid kidney recovery.
Received 18 January 2024 | Revised 14 March 2024 | Accepted 2 May 2024
DOI: 10.35755/jmedassocthai.2024.S01.S136-S141
Keywords : Acute kidney injury; Aminoglycoside; Bartter syndrome; Hyponatremia; Nephrotoxicity
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