Management of DR-TB ADR: Electrolyte Disturbances

Electrolyte disturbances are a rare but serious Adverse Drug Reaction (ADR) that can cause symptoms like irregular heartbeat, fatigue or lethargy, convulsions or seizures, nausea, vomiting and muscle spasms. It requires serum electrolyte lab tests for diagnosis.

This ADR is best managed at the Drug-resistant TB (DR-TB) centre where the patient can be admitted and administered treatment.

Suspected agent(s): Amikacin (Am)

Suggested Management Strategies

• Evaluate the potassium levels.
• If potassium is low, check for magnesium and calcium (if unable to check for magnesium, consider empiric treatment with magnesium in all patients of hypokalaemia).
• Replace electrolytes as needed. Dose oral electrolytes apart from Fluoroquinolone (FQ) as they can interfere with FQ absorption.
• Manage electrolyte disturbances.

Points to Note

• If severe hypokalaemia is present, consider hospitalization.
• Amiloride, 5-10 mg daily, or spironolactone, 25 mg daily, may decrease potassium and magnesium wasting and thus, is useful in refractory patients.
• Oral potassium replacements can cause significant nausea and vomiting and oral magnesium may cause diarrhoea.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021. 
• Ready Reckoner for Medical Officer - Adverse Drug Reactions Associated with Anti-TB Drugs Identification and Management, 2019.​

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