Nafcillin-Associated Hypokalemia

Nafcillin 투여에 따른 저칼륨혈증 1예

Hypokalemia is a common finding in various clinical settings; it is associated with diuretic use and loss of potassium via the gastrointestinal tract. Less common causes are renal tubular acidosis, diabetic ketoacidosis, excess insulin, primary hyperaldosteronism, and medications, such as amphotericin B. Nafcillin, a narrow-spectrum penicillin class antibiotic, which is selectively prescribed for methicillin-susceptible Staphylococcal aureus infections, and is commonly associated with gastrointestinal side effects, such as nausea, vomiting, and abdominal pain. However, in rare cases it can cause hypokalemia, which is usually overlooked. Severe hypokalemia was detected in a 59-year-old male patient hospitalized due to traumatic cerebral hemorrhage who received 12 g of nafcillin per day for more than 2 weeks for sepsis caused by methicillin-sensitive Staphylococcus epidermidis. We confirmed the association between nafcillin and hypokalemia through further evaluation and a review of the relevant literature. Clinicians should be aware of hypokalemia as a complication when using high doses of nafcillin.

저칼륨혈증은 다양한 원인으로 나타날 수 있으나 amphoterin B 외의 항생제와의 관련성은 잘 알려져 있지 않아 간과되기 쉽다. Nafcillin 투여 시 비록 가능성은 낮게 보고되고 있으나 장기간 고용량이 투여되는 환자에게서는 심각한 저칼륨혈증이 발생할 수 있으므로 임상의사들은 이를 숙지하여 칼륨 농도를 반드시 추적 관찰하고 조기에 교정해야 하겠다.