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Renal Wasting of Electrolytes: Effect of Amikacin Used to Treat Infections - Tip of Iceberg for the Physicians


Article Information

Title: Renal Wasting of Electrolytes: Effect of Amikacin Used to Treat Infections - Tip of Iceberg for the Physicians

Authors: Batool Butt, Khalid Raja, Ismail Ahmed

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History
Category From To
Y 2024-10-01 2025-12-31
Y 2023-07-01 2024-09-30
Y 2021-07-01 2022-06-30
Y 2020-07-01 2021-06-30
Y 1900-01-01 2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2023

Volume: 73

Issue: Supplementary 1

Language: English

DOI: 10.51253/pafmj.v73iSUPPL-1.3886

Keywords: AmikacinElectrolyte wastingInfections

Categories

Abstract

Objective: To measure prospectively the effect of treatment with the Amikacin on renal magnesium, potassium and phosphate wasting in patients with extrarenal infections.
Study Design: Case series.
Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi Pakistan from Jul toDec 2019.
Methodology: A total of 40 cases were included in this study in liaison with other departments who were put on Amikacinstandard dose. Urinary electrolytes including potassium, magnesium and phosphate were measured at day 4 after the use of Amikacin. Factors like age, gender, cause for which Amikacin was used, day 1 creatinine and day 4 creatinine were correlated with presence of electrolyte wasting in the target population.
Results: Mean age of study participants was 39.1±12.56 years. 25(62.5%) were males while 15(37.5%) were females. Commonest cause for the use of Amikacin was drug resistant tuberculosis followed by fractures. Mean urinary magnesium was 39.1±12.56 mmol/24 hours, while potassium was 26.1±15.60 meq/24 hours. Mean phosphate was 66.4±53.55 mg/24 hours. Pearson chi-square test revealed that advanced age and day 4 creatinine were strongly linked with the presence of urinary electrolyte wasting among the patients receiving Amikacin for extra-renal infections with p-value<0.05.
Conclusion: Electrolyte wasting emerged as a common finding in the patients put on Amikacin suffering from extra renal infections. Patients with advancing age put on Amikacin should be given special attention and screened for electrolyte wasting at priority. ..


Research Objective

To prospectively measure the effect of Amikacin treatment on renal magnesium, potassium, and phosphate wasting in patients with extrarenal infections.


Methodology

Case series conducted over six months (July-December 2019) at Pak Emirates Military Hospital. 40 patients with extrarenal infections receiving Amikacin were included. Urinary electrolytes (potassium, magnesium, phosphate) were measured on day 4 of Amikacin use. Factors like age, gender, cause for Amikacin use, and day 1 and day 4 creatinine levels were correlated with electrolyte wasting.

Methodology Flowchart
                        graph TD
    A["Recruit 40 patients with extrarenal infections on Amikacin"] --> B["Measure urinary electrolytes"Mg, K, P" on Day 4"];
    B --> C["Record age, gender, cause for Amikacin, Day 1 & Day 4 creatinine"];
    C --> D["Analyze data using Pearson chi-square test"];
    D --> E["Identify correlations between variables and electrolyte wasting"];
    E --> F["Draw conclusions on Amikacin's effect on renal electrolyte wasting"];                    

Discussion

Amikacin use was associated with electrolyte wasting, particularly magnesium, in patients with extrarenal infections. Advanced age and elevated day 4 creatinine levels were identified as risk factors for this wasting. The study suggests that electrolyte wasting can be an early indicator of renal damage from Amikacin, even when creatinine levels are not significantly elevated. The authors acknowledge limitations, including the lack of baseline electrolyte measurements and the difficulty in differentiating electrolyte wasting caused by the underlying infection versus the antibiotic.


Key Findings

- Mean age of participants was 39.1±12.56 years; 62.5% were males.
- Common causes for Amikacin use were drug-resistant tuberculosis and fractures.
- Mean urinary magnesium was 39.1±12.56 mmol/24 hours, potassium was 26.1±15.60 meq/24 hours, and phosphate was 66.4±53.55 mg/24 hours.
- Advanced age and day 4 creatinine levels were strongly linked with the presence of urinary electrolyte wasting (p-value < 0.05).
- 72.5% of patients showed at least one type of electrolyte wasting.


Conclusion

Electrolyte wasting is a common finding in patients treated with Amikacin for extrarenal infections. Clinicians should pay close attention to elderly patients on Amikacin and screen them for electrolyte wasting. Day 4 creatinine levels and urinary electrolytes could be incorporated into routine screening to assess renal damage or electrolyte wasting.


Fact Check

- Study duration: July to December 2019. (Confirmed in Methodology section)
- Number of participants: 40 cases were included. (Confirmed in Methodology and Results sections)
- Percentage of male participants: 62.5% were males. (Confirmed in Results section)


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