RESUMO
WHAT IS KNOWN AND OBJECTIVE: Nafamostat mesylate (NM) is used clinically in combination with antiviral drugs to treat coronavirus disease (COVID-19). One of the adverse events of NM is hyperkalaemia due to inhibition of the amiloride-sensitive sodium channels (ENaC). The incidence and risk factors for hyperkalaemia due to NM have been studied in patients with pancreatitis but not in COVID-19. COVID-19 can be associated with hypokalaemia or hyperkalaemia, and SARS-CoV-2 is thought to inhibit ENaC. Therefore, frequency and risk factors for hyperkalaemia due to NM may differ between COVID-19 and pancreatitis. Hyperkalaemia may worsen the respiratory condition of patients. The objective of this study was to determine the incidence and risk factors for hyperkalaemia in COVID-19 patients treated with favipiravir, dexamethasone and NM. METHODS: This retrospective study reviewed the records of hospitalized COVID-19 patients treated with favipiravir and dexamethasone, with or without NM, between March 2020 and January 2021. Multivariable logistic regression analysis was performed to identify the risk factors for hyperkalaemia. RESULTS AND DISCUSSION: Of 45 patients who received favipiravir and dexamethasone with NM for the treatment of COVID-19, 21 (47%) experienced hyperkalaemia. The duration of NM administration was a significant predictor of hyperkalaemia (odds ratio: 1.55, 95% confidence interval: 1.04-2.31, p = 0.031). The receiver-operating characteristic curve analysis determined that the cut-off value for predicting the number of days until the onset of hyperkalaemia was 6 days and the area under the curve was 0.707. WHAT IS NEW AND CONCLUSION: This study revealed that the incidence of hyperkalaemia is high in patients treated for COVID-19 with NM, and that the duration of NM administration is a key risk factor. When NM is administered for the treatment of COVID-19, it should be discontinued within 6 days to minimize the risk of hyperkalaemia.
Assuntos
Tratamento Farmacológico da COVID-19 , Hiperpotassemia , Pancreatite , Benzamidinas , Dexametasona , Guanidinas , Humanos , Hiperpotassemia/induzido quimicamente , Hiperpotassemia/tratamento farmacológico , Hiperpotassemia/epidemiologia , Incidência , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2Assuntos
Adenocarcinoma de Pulmão/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Grandes/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Terapia de Salvação , Adenocarcinoma de Pulmão/patologia , Adulto , Idoso , Bevacizumab/administração & dosagem , Carcinoma de Células Grandes/patologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Docetaxel/administração & dosagem , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Taxa de SobrevidaRESUMO
We present a case of acute respiratory distress syndrome (ARDS) caused by allergic reactions to a herbal drug Saiko-karyuukotu-boreitou. A 57-year-old woman was admitted with a chief complaint of dry cough and dyspnea. She had been treated with Saiko-karyuukotsu-boreitou for postoperative pain and insomnia. Chest radiographs on admission showed diffuse infiltration shadows in both lungs. Chest CT scan showed diffuse ground glass opacities, consolidation and air bronchogram. Drug stimulation test was positive for Saiko-karyuukotu-boreitou. Based on the above findings, we diagnosed this case as Saiko-karyuukotu-boreitou-induced pneumonia. The patient recovered after discontinuation of Saiko-karyuukotu-boreitou. This is the fourth reported case of pneumonia induced by Saiko-karyuukotu-boreitou. We recommend careful observation when this medicine is prescribed.
