Renal tubular acidosis associated with trimethoprim-sulfamethoxazole poisoning

Abstract

The combination of trimethoprim-sulfamethoxazole (TMP-SMZ or co-trimoxazole) has a bactericidal effect on gram-positive cocci and gram-negative bacilli. It is used clinically for skin and soft tissue, respiratory and urinary tract infections, and is also relevant for prophylaxis and treatment of opportunistic infections in immunosuppressed patients.

Its use at established doses in immunocompetent patients is safe, with a low rate of adverse events. However, in immunosuppressed individuals (human immunodeficiency virus [HIV], transplants, or steroid users), the adverse effects (AEs) of this medication reach 83%; and, when administered parenterally at high doses, lactic acidosis has been documented secondary to the polyethylene glycol vehicle.

We present two cases of patients who ingested an overdose of TMP-SMZ and developed type 2 renal tubular acidosis (RTA), which has not been described with this medication, and whose hyperlactatemia is not explained by the polyethylene glycol excipient, as it was taken orally

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Author Biographies

Daniela Perdomo Quintero, general practitioner
General doctor. Surcolombiana University
Camilo Ernesto Gomez Barrios, general practitioner

General practitioner. Surcolombiana University

Adriana Zamora Suarez, specialist
Medica toxicologist. Hernando Moncaleano Perdomo University Hospital Surcolombiana University teacher.
Juan Camilo Cifuentes Gonzalez, Hospital Universitario Hernando Moncaleano Perdomo (Neiva, Colombia)
Internal Medicine specialist doctor. Hernando Moncaleano Perdomo University Hospital. Neiva, Huila, Colombia. Surcolombiana University teacher. Neiva, Huila, Colombia. Member of the Colombian Association of Internal Medicine (ACMI). High Magdalena Chapter.
Published
2020-06-30
How to Cite
Perdomo Quintero, D., Gomez Barrios, C. E., Zamora Suarez, A., & Cifuentes Gonzalez, J. C. (2020). Renal tubular acidosis associated with trimethoprim-sulfamethoxazole poisoning. Acta Médica Colombiana, 45(4). https://doi.org/10.36104/amc.2020.1869