Hyperkalemia, Bactrim and kidneys? And HCTZ?

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cured4real?
Veteran Member


Date Joined Dec 2005
Total Posts : 1942
   Posted 12/15/2009 10:32 AM (GMT -7)   
Hi--
I got a solumedrol injection in my lumbar spine and had an infected bite. The infection, almost gone completely, got worse, of course. So no big deal get on Bactrim. but I ended up in the ER with hyperkalemia and was there for a long time and they won't do diddly to dx there or tell me anything. And the doc couldnt give me any advice on diet or anything.  Anyone have any experience with this?  The local nephrologist insists I have no kidney disease without seeing me at all, telling my familydoc who tries  to refer me that its a waste of time.
 
I put a call into rheumie, but he probably won't want to get involved in this one. If he helps me, it will be a big favoron his part since none of this has anything to do with him, except that he's really good and maybe the kidney thing is from AI disease and not the respective other diseases I have, though they like to pawn it off alot.  Its good though, they'll either get to the truth or wear themselves out. 
 
Any advice on how to manage this helpful diet stuff, anything, any tricks. The IV junk they gave me is going to wear off and my doctor has been awful to get in and see. 
 
Hey, should I be taking my HCTZ with this Bactrim? It was listed as a diuretic and it really makes me go alot.
 
 
 
 
Love, Marji
Ills--Sjogrens-Lupus cond., AI polygland. dysfunction 2, hyper/hypopigment, scoliosis,kyphosis,stenosis, deg.,O.A.,spine surgeries, salivary/lymphectomies, NASH, COPD, RLS, UT/GI bleeds, hystero, brain/nerve damage,TB
Meds--INH,Plaquenil, Evoxac, Metformin, Synthroid, HCTZ, HRT and Lidocaine patchs, Voltaren gel, Klonopin, Vicodin, Restasis, Albuterol, steroids


aimsgirl16
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Date Joined Jun 2008
Total Posts : 1434
   Posted 12/15/2009 1:56 PM (GMT -7)   
High Potassium...I had that not too long ago. My nephrologist cut back my Lisinopril (which he though was causing the high K) and told me to stay away from potatoes, bananas, beans, nuts, guacamolie (SP) until my potassium levels came down. I THINK that water pills can cause your potassium to go up so I would check with your rhumey, Please don't stop/start any meds without one of your doctors opinions. Also you had an infection....an infection causes WBC to go up and when your WBC goes up it can cause your potassium to go up.

Do you know what your creatinine, BUN, and GFR is? What makes you suspicious of Kidney Disease? Do you get up and go to the bathroom at night (several times), is your urine froathy or foamy? Is your urine colorful? Anywhere from light pink to coke color or red?

BumbleBee1
Regular Member


Date Joined Oct 2005
Total Posts : 130
   Posted 12/15/2009 3:06 PM (GMT -7)   
Hi

I am not sure if this post is relevant since it is about hypokalemia which is the only thing I know about HCTZ causing, that's to say, depletion or shortage of potassium. Whoever prescribed it should be taking responsibility - it is usual to test for side effects of medicines at regular intervals, bloods and electrolytes.
As you may know, the sulfonamides ( 'sulfa' antibiotics) such as Bactrim are best avoided by people with lupus as they can aggravate the disease, maybe in some cases even trigger it. HCTZ has a sulfa component although many people who do have problems with the sulfa antibiotics take it without problems- there isn't necessarily cross reactivity.


I would certainly want whoever prescribed the Bactrim to be aware that this sort of antibiotic is a no- no, unless there is no option. In my experience there always has been an option. I think the Bactrim can also cause hypokalemia but not sure and not sure how long it would take. I would almost certainly inform my rheumatologist about what's happened if only for his information and in case he wants to comment. It might be a good idea to try one of the potassium sparing diuretics.
A pharmacist should be able to comment on the advisability of taking the two together and whether there could have been such a serious interaction. For the possibility of kidney disease, the usual blood and urine tests can be done.

Initial treatment of hypokalemia at first might be potassium supplements, but foods rich in potassium are
* raisins
* prunes
* apricots
* dates
* strawberries
* bananas
* watermelon
* cantaloupe
* citrus fruits [orange juice]
* beets
* greens
* spinach
* tomatoes
* mushrooms
* soy products
* veggie burgers
* peas
* beans
* turkey
* fish
* beef
* salmon
* cod

Bananas and orange juice are very readily available without much effort. I do think you should contact one of your doctors for further advice and investigation or possible change of meds.

Best of luck

BB

aimsgirl16
Forum Moderator


Date Joined Jun 2008
Total Posts : 1434
   Posted 12/15/2009 3:17 PM (GMT -7)   
I have heard the same thing Bumble Bee although my rhuemy who specialized in lupus has put me on Bactrim Long term until Feb because my WBC falls from my meds...so is this a myth or fact about Sulfa drugs triggering or agravating Lupus? Also I believe marjie said Hyper not Hypo...

FW
Regular Member


Date Joined May 2007
Total Posts : 449
   Posted 12/16/2009 9:56 AM (GMT -7)   
Just curious -and not to hijack the thread - but my rheumy also put me on long term Bactrim. And a second rheumy I sometimes see, confirmed the prescription.

Also, my K was too low, and I am allergic to almost all of the foods on BB's list, so I started using "Lite Salt". High in potassium. Seems to have done the trick. Good Luck.
Take care, Fran

Dx: Lupus, sjogren's, celiac, severe allergies.
Daily Meds: Plaquenil, Zyrtec. Aciphex, Nasacort, Prozac, Ambien CR, CellCept
Daily Supplements: Calcium, B-100 Complex, Daily Vitamins.
As Needed Meds: Epinephrine, Benadryl, Proventil, Xopenex, Tylenal, Darvocet, Prednisone.


cured4real?
Veteran Member


Date Joined Dec 2005
Total Posts : 1942
   Posted 12/16/2009 2:44 PM (GMT -7)   
Hi Thanks so much Amy and  BB.  I finally got through to my docs nurse, they did call. And I told her flat out I was going try not taking the HCTZ for a day and see if it helped.  It has definitely helped out with me not going gallons and drinking way too excessively. I actually feel a little better.  My urine was completely clear, nothing in it, I was going so so much.
 
On the kidney thing, I had a battery of tests when I was about 4 years old for repeated kidney infections and suspicious bloodwork. They didn't find anything--that was in the 1960s (you know you're old when you have to put the first two digits of the date to be clear!!!). Anyway, the repeated infections followed me up until young adulthood, and thankfully went a way for a while, I was told in my teen years they felt I might just have had some kind of reflux problem that I would grow out of.  A few years ago after a uroscope, a urologist told me that he felt my ureters were "rough" inside and that a trial of men's prostate med would solve that. I never felt so bad, my liver didn't like it (I have severe NASH, really bad, this year they told me I would need a transplant--I'm not bad yet, but they feel it will not go on much longer until I go end stage). Also, this predisposes me to kidney problems from the severe liver damage.
 
I have positive P-ANCA, another marker for kidney disease, cannot see a nephrologist though even for a consult. I also have retroaortic left renal vein and my left kidney was a centimeter larger than the right on the imaging, the retroaortic left renal vein, from what I've read about it, is a precursor or sign of lupus nephritis, many of you may have it and not know it and your radiologists may have either seen it so much they don't note it or don't really even look so much at the veins and stuff. It can be a sign of cancer or other serious problems.  Its called nutcracker syndrome, the vein get pinched, the blood doesn't flow right and it hurts the kidney, then the other one is overburdened.  They don't really know why people develop RALRV, I had no clue the vascular system could reroute itself on its own, but most radiologists miss it and it is serious in many people and fixable with a shunt and repositioning of the vein. No one will do it for me.  It is so rare that it is not even listed in NORD--not because it really is, just probably underreported. The only reason Mayo caught it is that my liver doc is a transplant doc and I came in through liver transplant and it is an important issue in transplantation. Another good reason to fix it. Bending over and certain movements can cause problems because it cuts off blood flow to/from the kidney.
 
The docs in the US have ruined the eGFR by saying that the test, which is capable of predicting and staging kidney disease, should only measure whether someone is in end-stage kidney disease or not. Its really awful. I tried to write up something about it, but couldn't get anyone to speak about it. The ER wouldn't tell me about my kidneys, just told me to see the doc.
 
When I go to Mayo I am going to ask for a referral to a nephrologist there, if they will, just to discuss all this and see what they can do for me. I should be on lasix, like most liver patients, but it doesn't work for me, only the HCTZ.  So my water retention seems to be more from the UT side.
 
I'm doing much better without the HCTZ. I see the doc tomorrow and hopefully she will culture the sore and put me on an additional antibiotic (I don't think they want to quit the bactrim halfway through, I don't want to end up with a resistant infection).  It is black under the skin by my tailbone. I hope its not something like a necrotizing something or other from the spinal injections. That would be awful. 
 
Thanks so Amy and BB, I was hoping you all would reply. Amy I saw in a post before I had a problem that you were on bactrim, I don't know why I noticed it.  Weird what we notice.  Thanks so much you guys for being here.
Love, Marji
Ills--Sjogrens-Lupus cond., AI polygland. dysfunction 2, hyper/hypopigment, scoliosis,kyphosis,stenosis, deg.,O.A.,spine surgeries, salivary/lymphectomies, NASH, COPD, RLS, UT/GI bleeds, hystero, brain/nerve damage,TB
Meds--INH,Plaquenil, Evoxac, Metformin, Synthroid, HCTZ, HRT and Lidocaine patchs, Voltaren gel, Klonopin, Vicodin, Restasis, Albuterol, steroids


marlena21
New Member


Date Joined Jan 2010
Total Posts : 1
   Posted 1/18/2010 5:25 AM (GMT -7)   
I think the Bactrim antibiotic can also cause hypokalemia but not sure and not sure how long it would take. I would almost certainly inform my rheumatologist about what's happened if only for his information and in case he wants to comment. It might be a good idea to try one of the potassium sparing diuretics.
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