Electrolyte Blood Press.  2007 Dec;5(2):111-115. 10.5049/EBP.2007.5.2.111.

Antimicrobial-induced Electrolyte and Acid-Base Disturbances

  • 1Department of Internal Medicine, Inje University College of Medicine, Busan, Korea. kyw8625@chol.com


Antimicrobials are one of the most widely prescribed classes of therapeutic agents. Although adverse effects of antimicrobials are generally minimal and reversible, serious sequelae can sometimes remain, such as unusual forms of renal failure, acid base disturbance and electrolyte abnormalities. Many antimicrobials, especially vancomycin or aminoglycosides, are associated with development of acute renal failure caused by acute tubular necrosis, allergic acute interstitial nephritis, or vasculitis. Besides, some antimicrobial agents can cause serious fluid and electrolyte imbalance. To prevent these serious consequences, early recognition and correction of their harmful renal and electrolyte effects are required.

MeSH Terms

Acute Kidney Injury
Anti-Infective Agents
Nephritis, Interstitial
Renal Insufficiency
Anti-Infective Agents


1. Melnick JZ, Baum M, Thompson JR. Aminoglycoside-induced Fanconi's syndrome. Am J Kidney Dis. 1994; 23:118–122. PMID: 8285185.
2. Kang HS, Kerstan D, Dai L, Ritchie G, Quamme GA. Aminoglycosides inhibit hormone-stimulated Mg2+ uptake in mouse distal convoluted tubule cells. Can J Physiol Pharmacol. 2000; 78:595–602. PMID: 10958159.
3. Elliott C, Newman N, Madan A. Gentamicin effects on urinary electrolyte excretion in healthy subjects. Clin Pharmacol Ther. 2000; 67:16–21. PMID: 10668849.
4. Sawaya BP, Briggs JP, Schnermann J. Amphotericin B nephrotoxicity: the adverse consequences of altered membrane properties. J Am Soc Nephrol. 1995; 6:154–164. PMID: 7579079.
5. Barcia JP. Hyperkalemia associated with rapid infusion of conventional and lipid complex formulations of amphotericin B. Pharmacotherapy. 1998; 18:874–876. PMID: 9692667.
6. Choudhury D, Ahmed Z. Drug-induced nephrotoxicity. Med Clin North Am. 1997; 81:705–717. PMID: 9167653.
7. Sellin JH, De Soignie R. Ion transport in human colon in vitro. Gastroenterology. 1987; 93:441–448. PMID: 2440757.
8. Barton CH, Pahl M, Vaziri ND, Cesario T. Renal magnesium wasting associated with amphotericin B therapy. Am J Med. 1984; 77:471–474. PMID: 6475987.
9. Domingo P, Ferrer S, Cruz J, Morla R, Ris J. Trimethoprim-sulfamethoxazole-induced renal tubular acidosis in a patient with AIDS. Clin Infect Dis. 1995; 20:1435–1437. PMID: 7620045.
10. Schlanger LE, Kleyman TR, Ling BN. K+-sparing diuretic actions of trimethoprim: inhibition of Na+ channels in A6 distal nephron cells. Kidney Int. 1994; 45:1070–1076. PMID: 8007576.
11. Choi MJ, Fernandez PC, Patnaik A, Coupaye-Gerard B, D'Andrea D, Szerlip H, Kleyman TR. Brief report: trimethoprim-induced hyperkalemia in a patient with AIDS. N Engl J Med. 1993; 328:703–706. PMID: 8433730.
12. Velázquez H, Perazella MA, Wright FS, Ellison DH. Renal mechanism of trimethoprim-induced hyperkalemia. Ann Intern Med. 1993; 119:296–301. PMID: 8328738.
13. Rose BD. Jeffers JD, Novrozov M, editors. Metabolic acidosis. Clinical physiology of acid-base and electrolyte disorders. 1994. 4th ed. New York: McGraw-Hill;p. 540–603.
14. Morris AA, Baudouin SV, Snow MH. Renal tubular acidosis and hypophosphataemia after treatment with nucleoside reverse transcriptase inhibitors. AIDS. 2001; 15:140–141. PMID: 11192863.
15. Crowther MA, Callaghan W, Hodsman AB, Mackie ID. Dideoxyinosine-associated nephrotoxicity. AIDS. 1993; 7:131–132. PMID: 8442906.
16. Fisher EJ, Chaloner K, Cohn DL, Grant LB, Alston B, Brosgart CL, Schmetter B, El-Sadr WM, Sampson J. Terry Beirn Community Programs for Clinical Research on AIDS: The safety and efficacy of adefovir dipivoxil in patients with advanced HIV disease: a randomized, placebo-controlled trial. AIDS. 2001; 15:1695–1700. PMID: 11546945.
17. Vittecoq D, Dumitrescu L, Beaufils H, Deray G. Fanconi syndrome associated with cidofovir therapy. Antimicrob Agents Chemother. 1997; 41:1846. PMID: 9257778.
18. Navarro JF, Quereda C, Quereda C, Gallego N, Antela A, Mora C, Ortuno J. Nephrogenic diabetes insipidus and renal tubular acidosis secondary to foscarnet therapy. Am J Kidney Dis. 1996; 27:431–434. PMID: 8604715.
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