Hypomagnesemia pentamidine

Gradon JD, Fricchione L, Sepkowitz D. Severe hypomagnesemia associated with pentamidine therapy. Rev Infect Dis 1991 13(3) 511-2. 

Confusion and hallucinations have occasionally been reported with pentamidine. Magnesium deficiency may affect mental function a flat affect, slow speech, and mental withdrawal are some of the typical effects (SEDA-13, 825) (6). The symptoms of hypomagnesemia can be ill defined unexplained symptoms, despite improvement of the P. jiroveci infection, demand measurement of the serum magnesium concentration. 

In summary, parenteral pentamidine administration for the treatment of PCP can be associated with the development of usually mild, reversible acute kidney injury. Compounding risk factors, of which volume depletion is the most important, are found in the majority of cases of pentamidine nephrotoxicity. There is no convincing evidence that the aerosol route of pentamidine administration for PCP prophylaxis results in nephrotoxicity. Hypocalcemia and hypomagnesemia with renal magnesium wasting, and particularly, hyperkalemia are seen with pentamidine therapy. 

Shah GM, Alvarado P, Kirschenbaum MA. Symptomatic hypocalcemia and hypomagnesemia with renal magnesium wasting associated with pentamidine therapy in a patient with AiDS.The American journal of medicine. 1990 Sep 89(3) 380-2. 

Burnett RJ, Reents SB. Severe hypomagnesemia induced by pentamidine. Dicp. 1990 Mar 24(3) 239-40. 

Pentamidine therapy for Pneumocystis carinii infections is also limited by nephrotoxicity. Prospective studies have shown azotemia in 60% to 90% of treated patients. Hyperkalemia, metabolic acidosis, hypomagnesemia, and hypocalcemia may also occur. Toxicity is more frequent in patients with the acquired immunodeficiency syndrome (AIDS) than in patients without this immune deficiency, and may... 

Foscamet is highly ionized at physiological pH, and metabolic abnormalities are very common, including increases or decreases in Ca and phosphate, hypomagnesemia, and hypokalemia. Concomitant intravenous pentamidine administration increases the risk of hypocalcemia. 

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