Risk factors of ventricular fibrillation during rapid amphotericin B infusion

Author:

Craven P C,Gremillion D H

Abstract

Amphotericin B causes reversible concentration-dependent loss of intracellular potassium in vitro and hyperkalemic ventricular arrhythmias in dogs. Hyperkalemic ventricular arrhythmias associated with amphotericin B infusion have not been well documented in humans. Ventricular fibrillation with progressive hyperkalemia (up to 8 to 8.4 meq/liter) occurred twice in an anuric patient during rapid infusion of high-dose amphotericin B (1.4 mg/kg over 45 min). The peak amphotericin B concentration in serum at the end of infusion was 6.7 micrograms/ml. Prolonged infusion (3 h) and concurrent hemodialysis each prevented the development of hyperkalemia and ventricular arrhythmia. In two anuric patients receiving 4-h infusions of amphotericin B during dialysis (0.7 and 1.0 mg/kg), peak amphotericin B concentrations in serum were lower, 1.6 +/- 0.1 and 2.7 +/- 0.7 micrograms/ml, respectively; serum potassium levels were maintained in the normal range; and venous access for outpatient therapy was convenient. Peak concentrations of amphotericin B in serum were also lower (1.7 +/- 0.7 micrograms/ml) in eight patients with normal renal function who received lower doses (0.7 +/- 0.2 mg/kg) over 45 min; there were only slight increases in the serum potassium level (from 3.9 +/- 0.9 to 4.4 +/- 0.6 meq/liter, P less than 0.05). We recommend that rapid infusion of amphotericin B not be used in patients with impaired potassium excretion unless accompanied by hemodialysis and careful potassium monitoring.

Publisher

American Society for Microbiology

Subject

Infectious Diseases,Pharmacology (medical),Pharmacology

Reference15 articles.

1. Administration of amphotericin B;Barreuther A. D.;Drug Intell. Clin. Pharm.,1977

2. Bennett J. E. 1977. Amphotericin B binding to serum betalipoprotein p. 107. In K. Iwata (ed.) Recent advances in medical and veterinary mycology. University Park Press Baltimore.

3. Bennett J. E. 1979. Antifungal agents p. 343-353. In G. L. Mandell R. G. Douglas and J. E. Bennett (ed.) Principles and practice of infectious diseases. John Wiley & Sons Inc. New York.

4. A pharmacologic guide to the clinical use of amphotericin B;Bindschadler D. D.;J. Infect. Dis.,1969

5. Flucytosine and amphotericin B: hemodialysis effects on the plasma concentration and clearance;Block E. R.;Ann. Intern. Med.,1974

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