Refractory hyperkalaemia associated with trimethoprim-sulfamethoxazole therapy in neutropaenic sepsis

Hyperkalaemia is a potentially life threatening electrolyte disorder commonly seen in critically ill patients secondary to renal impairment. Herein, we report a case of severe hyperkalaemia, which was disproportionate to the degree of renal impairment, associated with neutropaenic sepsis, in a critically ill middle aged gentleman. Hyperkalaemia was refractory to medical treatment necessitating haemodialysis in the background of recent administration of trimethoprim- sulfamethoxazole (TMX-SMX) for presumed pneumocystis jiroveci pneumonia. It is important for clinicians to be aware of this complication as TMX-SMX is a popular antibiotic in immunocompromised populations.