A Dufour

BACKGROUND AND OBJECTIVES: Hyperkalemia affects up to 10% of patients with CKD. Sodium polystyrene sulfonate has long been prescribed for this condition, although evidence is lacking on its efficacy for the treatment of mild hyperkalemia over several days. This study aimed to evaluate the efficacy of sodium polystyrene sulfonate in the treatment of mild hyperkalemia. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 33 outpatients with CKD and mild hyperkalemia (5.0-5.9 mEq/L) in a single teaching hospital were included in this double-blind randomized clinical trial. We randomly assigned these patients to receive either placebo or sodium polystyrene sulfonate of 30 g orally one time per day for 7 days. The primary outcome was the comparison between study groups of the mean difference of serum potassium levels between the day after the last dose of treatment and baseline. RESULTS: The mean duration of treatment was 6.9 days. Sodium polystyrene sulfonate was superior to placebo in the reduction of serum potassium levels (mean difference between groups, -1.04 mEq/L; 95% confidence interval, -1.37 to -0.71). A higher proportion of patients in the sodium polystyrene sulfonate group attained normokalemia at the end of their treatment compared with those in the placebo group, but the difference did not reach statistical significance (73% versus 38%; P=0.07). There was a trend toward higher rates of electrolytic disturbances and an increase in gastrointestinal side effects in the group receiving sodium polystyrene sulfonate. CONCLUSIONS: Sodium polystyrene sulfonate was superior to placebo in reducing serum potassium over 7 days in patients with mild hyperkalemia and CKD.

Resume Objectif : Decrire le cas d’une jeune patiente presentant le syndrome de l’homme rouge accompagne de symptomes neurologiques lors de perfusions intraveineuses repetees de vancomycine. Resume du cas : Il s’agit d’une patiente de 32 ans prenant de la vancomycine intraveineuse pour traiter une neutropenie febrile persistante apres une greffe de cellules hematopoietiques. La patiente presentait des rougeurs, un prurit, des tremblements et des paresthesies au cours des perfusions d’antibiotique. Les symptomes persistaient malgre la diminution de la vitesse de perfusion et l’administration d’une premedication. Discussion : Les effets indesirables de la patiente sont probablement lies a la prise de vancomycine. Certains facteurs de risque, le lien temporel entre l’administration de l’antibiotique et l’apparition des symptomes, l’exclusion des autres causes possibles et la presence de quelques cas rapportes dans la documentation scientifique appuient cette association. Conclusion : Ce cas demontre que le syndrome de l’homme rouge peut s’accompagner de symptomes neurologiques et etre refractaire a une prise en charge rapide. La vigilance est donc de rigueur lorsque des effets secondaires rares se manifestent durant la prise de medicaments couramment utilises. Abstract Objective: To describe the case of a 32-year-old woman with red man syndrome accompanied by neurological symptoms during repeated intravenous infusions of vancomycin. Case summary: The patient received intravenous vancomycin for the treatment of persistent febrile neutropenia following a hematopoietic cell transplant. She presented with flushing, pruritus, tremors and paresthesia during the infusions of the antibiotic. The symptoms persisted despite decreasing the infusion rate and administering premedication. Discussion: The patient’s adverse effects were probably associated with the use of vancomycin. Certain risk factors, the temporal link between the administration of the antibiotic and the appearance of the symptoms, the exclusion of other possible causes, and the fact that a few cases have been reported in the scientific literature support this association. Conclusion: This case shows that red man syndrome can be accompanied by neurological symptoms and be refractory to prompt management. Vigilance should therefore be exercised when rare adverse effects occur during the administration of commonly used medications.