We present a report of markedly elevated calcium and magnesium requirements in an AIDS patient receiving central venous nutrition. These increased requirements were attributed to urinary magnesium losses associated with intravenous pentamidine therapy. The combination of intravenous pentamidine and electrolyte abnormalities resulted in the development of the dysrhythmia, torsade de pointes, in the patient. A review of literature presenting similar cases is included. Nutrition practitioners should be aware of the often prolonged effect of intravenous pentamidine on magnesium and calcium homeostasis so that adequate supplementation will be provided, perhaps preventing the development of life-threatening torsade de pointes.
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References
1.
Salamone FR, Cunha BAUpdate on pentamidine for the treatment of pneumocystis carinii pneumonia . Clin Pharm1988;7:501-10.
2.
McEvoy G, ed. AHFS-Drug Information. Bethesda, MD: American Society of Hospital Pharmacists, 1994:545-54.
3.
Mani S., Kocheril AG, Andriole VTCase report: pentamidine and polymorphic ventricular tachycardia revisited . Am J Med Sci1993;305:236-40.
4.
Precup A, ed. USP-DI, Vol 1. 14th ed. Rockville, Maryland: The United States Pharmacopeial Convention, 1994:2186-92.
5.
Goa KL, Campoli-Richards DMPentamidine isethionate: a review of its antiprotozoal activity, pharmacokinetic properties and therapeutic use in Pneumocystis carinii pneumonia. Drugs1987;33:242-58.
6.
Josephson ME , Buxton AE, Marchlinski FEThe tachyarrhythmias. In: Wilson JD, Braunwald E, Isselbacher KJ, et al, eds. Harrison's principles of internal medicine . 12th ed. Philadelphia: WB Saunders , 1991:116-60.
7.
Kay GN, Plumb VJ, Arciniegas JG, et al. Torsade de pointes: the long-short initiating sequence and other clinical features : observations in 32 patients. J Am Coll Cardiol1983;2:806-17.
8.
Tzivoni D., Keren A., Cohen AM, et al. Magnesium therapy for torsades de pointes. Am J Cardiol1984;53:528-30.
9.
Cortese LM, Gasser RA, Bjornson DC, et al. Prolonged recurrence of pentamidine-induced torsades de pointes . Ann Pharmacother1992;26:1365-9.
10.
Miller HCCardiac arrest after intravenous pentamidine in an infant. Pediatr Infect Dis J1993;12:694-6.
11.
Stein KM, Haronian H., Mensah GA, et al. Ventricular tachycardia and torsades de pointes complicating pentamidine therapy of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Am J Cardiol1990;66:888-9.
12.
Wharton JM, Demopulos PA, Goldschlager N.Torsade de pointes during administration of pentamidine isethionate . Am J Med1987;83:571-6.
13.
Bibler MR, Chou TC, Toltzis RJ, et al. Recurrent ventricular tachycardia due to pentamidine-induced cardiotoxicity. Chest1988;94:1303-6.
14.
Gonzalez A. , Sager PT, Akil B., et al. Pentamidine-induced torsade de pointes . Am Heart J1991;122:1489-92.
15.
Green PT, Reents S., Harman E., et al. Pentamidine-induced torsades de pointes in a renal transplant recipient with Pneumocystis carinii pneumonia. South Med J1990;83:481-4.
16.
Harel Y., Scott WA, Szeinberg A., et al. Pentamidine-induced torsades de pointes. Pediatr Infect Dis J1993;12:692-4.
17.
Mitchell P., Dodek P., Lawson L., et al. Torsades de pointes during intravenous pentamidine isethionate therapy. Can Med Assoc J1989;140:173-4.
18.
Quadrel MA, Atkin SH, Jaker MADelayed cardiotoxicity during treatment with intravenous pentamidine: two case reports and a review of the literature. Am Heart J1992; 123:1377-9.
19.
Pujol M., Carratala J., Mauri J., et al. Ventricular tachycardia due to pentamidine isethionate. Am J Med1988;84:980.
20.
Agus ZS, Wasserstein A., Goldfarb S.Disorders of calcium and magnesium homeostasis. Am J Med1982;72:473-88.
21.
Gums JGClinical significance of magnesium: a review. DICP-Ann Pharmacother1987;21:240-6.
22.
Burnett RJ, Reents SBSevere hypomagnesemia induced by pentamidine. DICP-Ann Pharmacother1990;24:239-40.
23.
Mani S.Pentamidine-induced renal magnesium wasting. AIDS (Phila)1992;6:594-5.
Shah GM, Alvarado P., Kirshenbaum MASymptomatic hypocalcemia and hypomagnesemia with renal magnesium wasting associated with pentamidine therapy in patients with AIDS. Am J Med1990;89:380-2.
26.
Lachaal M., Venuto RCNephrotoxicity and hyperkalemia in patients with acquired immunodeficiency syndrome treated with pentamidine. Am J Med1989;87:260-3.
27.
Dubey A., Solomon R.Magnesium, myocardial ischemia and arrhythmias, the role of magnesium in myocardial infarction. Drugs1989;37:1-7.
28.
Grant J.Handbook of total parenteral nutrition. 2nd ed. Philadelphia: WB Saunders , 1992:180.
