1/
[How] does aminoglycoside hypomagnesemia?
I've long assumed that aminoglycoside's primary toxicities are nephrotoxicity, ototoxicity, and neuromuscular blockade.
we know a little about potential Electrolyte abnormalities
ARE you ready for a #tweetorial?🧵
#medtwitter
[How] does aminoglycoside hypomagnesemia?
I've long assumed that aminoglycoside's primary toxicities are nephrotoxicity, ototoxicity, and neuromuscular blockade.
we know a little about potential Electrolyte abnormalities
ARE you ready for a #tweetorial?🧵
#medtwitter
2/
First, a question.
Which of the following isn't characteristic of the Electrolyte abnormalities caused by aminoglycosides ? #MedEd
First, a question.
Which of the following isn't characteristic of the Electrolyte abnormalities caused by aminoglycosides ? #MedEd
3/
-Aminoglycoside antibiotics are very effective in the treatment of gram‐negative organisms🦠
-The pathogenesis of aminoglycoside‐induced nephrotoxicity is well documented (Tulkens, 1989; Kacew, 1990).
-Aminoglycoside antibiotics are very effective in the treatment of gram‐negative organisms🦠
-The pathogenesis of aminoglycoside‐induced nephrotoxicity is well documented (Tulkens, 1989; Kacew, 1990).
4/
disturbance of electrolyte homeostasis, potentially serious but less well‐documented side‐effect of aminoglycoside therapy.
A syndrome of⬇️mg+,⬇️ca+ and⬇️k+ in patients receiving aminoglycoside therapy (Kelnar et al., 1978; Watson et al., 1983; Zaloga et al., 1984)
disturbance of electrolyte homeostasis, potentially serious but less well‐documented side‐effect of aminoglycoside therapy.
A syndrome of⬇️mg+,⬇️ca+ and⬇️k+ in patients receiving aminoglycoside therapy (Kelnar et al., 1978; Watson et al., 1983; Zaloga et al., 1984)
5/
back in 1984,
it was difficult to establish the relationship between gentamicin and⬇️mg+ due to:
1) large doses of gentamicin
2) concomitant administration of other antibiotics and cytotoxic agents
3) failure to monitor drug levels
4) poor oral intake.
back in 1984,
it was difficult to establish the relationship between gentamicin and⬇️mg+ due to:
1) large doses of gentamicin
2) concomitant administration of other antibiotics and cytotoxic agents
3) failure to monitor drug levels
4) poor oral intake.
6/
animal studies have therefore proved useful.
Early animal studies focused on the renal effects of chronic aminoglycoside administration to rats🐭 or dogs🐶.
animal studies have therefore proved useful.
Early animal studies focused on the renal effects of chronic aminoglycoside administration to rats🐭 or dogs🐶.
7/
It was therefore difficult to determine whether the renal functional changes resulted from a direct action of gentamicin or were secondary to the loss of renal tubular integrity.
It was therefore difficult to determine whether the renal functional changes resulted from a direct action of gentamicin or were secondary to the loss of renal tubular integrity.
8/
they found that as early as 30min after gentamicin renal perfusion or 3h after administration to rats, deficient reuptake of ca+ and mg+ is observed, leading to hypercalciuria, hypermagnesiuresis, and ⬇️serum mg+
these responses were related to the dose of the drug
they found that as early as 30min after gentamicin renal perfusion or 3h after administration to rats, deficient reuptake of ca+ and mg+ is observed, leading to hypercalciuria, hypermagnesiuresis, and ⬇️serum mg+
these responses were related to the dose of the drug
9/
in 1990, Seven patients (3 females, 4 males) developed symptomatic hypomagnesemia, hypocalcemia, and hypokalemia following gentamicin therapy.
A significant correlation was found between the total cumulative dose of gentamicin and serum Mg concentration
in 1990, Seven patients (3 females, 4 males) developed symptomatic hypomagnesemia, hypocalcemia, and hypokalemia following gentamicin therapy.
A significant correlation was found between the total cumulative dose of gentamicin and serum Mg concentration
10/
another study was published in CHEST 1989
- the serum magnesium (Mg) concentration was measured in samples of blood collected from 193 patients admitted to two postoperative ICUs
-those with severe ⬇️mg+ received aminoglycosides more often than those with normal serum Mg+
another study was published in CHEST 1989
- the serum magnesium (Mg) concentration was measured in samples of blood collected from 193 patients admitted to two postoperative ICUs
-those with severe ⬇️mg+ received aminoglycosides more often than those with normal serum Mg+
11/
The tubular toxicity of gentamicin presents two aspects:
1⃣ the death of tubular epithelial cells, mainly within the proximal segment.
2⃣ the non-lethal, functional alteration of key cellular components involved in water and solute transport.
The tubular toxicity of gentamicin presents two aspects:
1⃣ the death of tubular epithelial cells, mainly within the proximal segment.
2⃣ the non-lethal, functional alteration of key cellular components involved in water and solute transport.
12/
The absence of changes in renal cellular morphology indicates that the excessive renal losses of calcium and magnesium were an effect of gentamicin per se and not the result of underlying renal tubular injury
doi.org/10.1038/sj.bjp…
The absence of changes in renal cellular morphology indicates that the excessive renal losses of calcium and magnesium were an effect of gentamicin per se and not the result of underlying renal tubular injury
doi.org/10.1038/sj.bjp…
13/
Treatment of aminoglycoside-induced magnesium-wasting consists of the administration of oral or intravenous magnesium supplements. However, the efficacy of this oral regimen is limited by the urinary excretion of most of the extra magnesium
Treatment of aminoglycoside-induced magnesium-wasting consists of the administration of oral or intravenous magnesium supplements. However, the efficacy of this oral regimen is limited by the urinary excretion of most of the extra magnesium
14/
Fortunately, In most cases, aminoglycoside nephrotoxicity is reversible.
Serial monitoring and correction of serum magnesium/electrolyte/creatinine in patients receiving aminoglycosides is recommended.
#NephTwitter #tweetiatrician #Nephpearls #nephjc
Fortunately, In most cases, aminoglycoside nephrotoxicity is reversible.
Serial monitoring and correction of serum magnesium/electrolyte/creatinine in patients receiving aminoglycosides is recommended.
#NephTwitter #tweetiatrician #Nephpearls #nephjc
15/end
I thought that this entity can be worth mentioning in #UncleBob @medrants rounds & during @UnremarkableLab sessions.
@MedTweetorials
I thought that this entity can be worth mentioning in #UncleBob @medrants rounds & during @UnremarkableLab sessions.
@MedTweetorials
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