Electrolyte disorders during vancomycin treatment in hospitalized patients at hematology-oncology wards of Namazi hospital in Shiraz

Document Type : Research(Original) Article


1 Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran

2 Hematology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

3 Nephrology-Urology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

4 Basic Sciences in Infectious Diseases Research Center and Department of Medical Mycology and Parasitology, Shiraz University of Medical Sciences, Shiraz, Iran


Increased serum creatinine level and decreased glomerular filtration rate are the major features of vancomycin nephrotoxicity. Electrolyte disorders of this agent have not been considered in relevant clinical studies so far. The aim of the present study was to determine potassium and magnesium disorders in patients with hematologic and oncologic diseases under vancomycin treatment. A cross-sectional, observational study was performed during 9 months at three hematology-oncology wards of Namazi hospital in Shiraz. Patients > 18 years with no documented history of acute kidney injury or chronic kidney disease planned to receive vancomycin for at least 1 week were recruited. Urine samples for determining creatinine, potassium, and magnesium levels were collected at days 0, 3, 5, 7, 10, and 14 of treatment. Hypokalemia and hypomagnesemia was defined as serum potassium and magnesium level below 3 mEq/L and 1.2 mEq/L, respectively. Two-fifth (40.38%) of the study population developed hypokalemia during 2 to 3 days after initiating vancomycin. Hypomagnesemia was detected in 5.77% of vancomycin recipients with the time onset of 7.67 ± 3.21 days. The mean ± standard deviation of potassium supplement was significantly higher in patients with than those without hypokalemia (P = 0.006). No case of renal potassium and magnesium wasting was identified. Amphotericin b co-administration significantly associated with hypokalemia during vancomycin treatment (odds ratio = 0.164 [95% confidence interval = 0.041-0.647], P = 0.01). In contrast to hypomagnesemia, hypokalemia occurred commonly during the first days of vancomycin treatment. However, the real casual relationship, mechanism, and clinical outcome of these electrolyte disorders in vancomycin recipients remain unclear. 

  1. - Zietse R, Zoutendijk R, Hoorn EJ. Fluid, electrolyte and acid-base disorders associated with antibiotic therapy. Nat Rev Nephrol. 2009;5(4):193-202.
  2. - Elyasi S, Khalili H, Dashti-Khavidaki S, Mohammadpour A. Vancomycin-induced nephrotoxicity: mechanism, incidence, risk factors and special populations. A literature review. Eur J Clin Pharmacol. 2012;68(9):1243-55.
  3. - KDIGO Clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012.2(Suppl 1):8. Availablefrom:http://www.kdigo.org/Clinical%20Practice%20Conferences/Nagoya%202015/KDIGO%20AKI%20GL%20for%20JSN_wm.pdf [Last accessed 10 June 2016].
  4. - KDOQI Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Available from: http://www.kidney.org/professionals/KDOQI/guidelines_ckd/toc.htm [Last accessed 14 June 2016].
  5. - Gupta A, Biyani M, Khaira A. Vancomycin nephrotoxicity: myths and facts. Neth J Med. 2011;69(9):379-83.
  6. - Common Terminology Criteria for Adverse Events (CTCAE), Version 4.0. June 2010. Available at: http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf. [Last accessed 18 June 2016].
  7. - Mount DB. Evaluation of the patient with hypokalemia. In: UpToDate, Sterns RH, Emmett M (Eds), UpToDate, Waltham, MA, 2016. Available from: http://www.uptodate.com/contents/evaluation-of-the-adult-patient-with-hypokalemia [Last accessed 18 June 2016].
  8. - Elisaf M, Panteli K, Theodorou J, Siamopoulos KC. Fractional excretion of magnesium in normal subjects and in patients with hypomagnesemia. Magnes Res 1997;10:315-20.
  9. - Siau K. Hypokalaemia and cardiac arrest complicating vancomycin and furosemide therapy: a case report. Cases J. 2009;2:8244.
  10. - Wazny LD, Brophy DF. Amiloride for the prevention of amphotericin B-induced hypokalemia and hypomagnesemia. Ann Pharmacother. 2000;34:94-7.
  11. - Atsmon J, Dolev E. Drug-induced hypomagnesaemia: scope and management. Drug Saf. 2005;28:763-88.
  12. - Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011;52(4):e56-93.
  13. - Ben Salem C, Hmouda H, Bouraoui K. Drug-induced hypokalaemia. Curr Drug Saf. 2009;4(1):55-61.
  14. - Karimzadeh I, Khalili H, Farsaei S, Dashti-Khavidaki S, Sagheb MM. Role of diuretics and lipid formulations in the prevention of amphotericin B-induced nephrotoxicity. Eur J Clin Pharmacol. 2013;69(7):1351-68.