REFRACTORY HYPOKALEMIA – A MANIFESTATION OF AMPHOTERICIN TOXICITY
Dr.Vina Bang led Team OCHRI complimented for the expertise
One 57-year-old hypertensive diabetic male from Hinganghat was admitted to Nagpur based Orange City Hospital & Research Institute with complaints of tingling sensation in all four limbs especially in morning hours (at around 4am). Patient had history of post Covid Mucormycosis for which he had received Amphotericin for long time in recent past. He was admitted under care of Dr. Vina Bang- OCHRI Physician & Dr. Darshan Rewanwar- OCHRI Plastic Surgeon. On detail evaluation, He was found to have hypokalemia, polyuria, hypomagnesemia and postural hypotension. He also had issues including hypocalcemia and hypovitaminosis- D leading to secondary hyperparathyroidism. He had recurrent hypoglycemic episodes. Postural hypotension was there because of dehydration secondary to polyuria. He was thoroughly investigated & evaluated at OCHRI. He had metabolic alkalosis with increased urinary potassium and normal serum creatinine. His cortisol levels were normal, Aldosterone levels low normal which ruled out adrenal cause of hypokalemia. His diagnosis was Drug induced Giatalmen Syndrome with Nephrogenic Diabetes Insipidus- Amphotericin Induced with Penile Paraphimosis with Autonomic Neuropathy with Hypocalcemia with Hypovitaminosis D with Secondary Hyperparathyroidism with Vit B12 Deficiency with h/o Post Covid Mucormycosis in a known case of HT and DM2.
Dr. Vina Bang -OCHRI Physician informed that, “Considering his recent exposure to Amphotericin, we reviewed the literature and found that his clinical profile fits into Amphotericin induced Nephrotoxicity leading to Dyselectrolytemia and Nephrogenic Diabetes Insipidus as all features were present. She further added that, He was given IV potassium and magnesium correction. Even after magnesium correction, hypokalemia was not being corrected with potassium supplements needing up to 120meq/24hrs, but potassium levels used to drop as soon as correction was tapered. This refractory HYPOKALEMIA continued for next 3 to 4 days. After that, potassium levels started showing rising trend. Over a period of 1week IV potassium correction was tapered slowly and later stopped. Oral supplements were continued. He was started on potassium sparing diuretic (spironolactone). He was corrected for hypocalcemia, vitamin D deficiency and vitamin B12 deficiency. Gradually his symptoms decreased and sugars were stabilized. Over a period of next 2 weeks’ oral potassium also stopped only spironolactone was continued.
Simultaneously Dr. Darshan Rewanwar-Plastic Surgeon, Dr. Jitesh Jeswani- Nephrologist, Dr. Abhay Agashe- Ophthalmologist, Dr. Mohan Shendre- Dermatologist and Dr. Pratima Shenoi- Dental Surgeon treated him for allied problems. During regular follow-ups, his spironolactone is also tapered. In recent follow up this patient is off the drug (spironolactone) and potassium supplements. He is totally symptom free with normal sugars and is normotensive.
His relatives thanked Dr. Vina Bang & TEAM OCHRI for successful comprehensive treatment at OCHRI. Medical fraternity have commended Team OCHRI for this successful diagnosis and treatment which will help many such undiagnosed patients.