Hypokalemia among patients receiving treatment for multidrug-resistant tuberculosis

Chest. 2004 Mar;125(3):974-80. doi: 10.1378/chest.125.3.974.


Introduction: Between January 1999 and December 2000, 125 patients in Lima, Peru were enrolled in individualized treatment for multidrug-resistant tuberculosis (MDR-TB). Hypokalemia was observed to be an important adverse effect encountered in this cohort.

Objective: To identify risk factors associated with the development and persistence of hypokalemia during MDR-TB therapy, and to review the incidence and management of hypokalemia in patients receiving MDR-TB therapy.

Methods: A retrospective case series of 125 patients who received individualized therapy for MDR-TB between January 1, 1999, and December 31, 2000.

Results: Among 115 patients who were screened for electrolyte abnormalities, 31.3% had hypokalemia, defined as a potassium level of < 3.5 mEq/L. Mean serum potassium at time of diagnosis was 2.85 mEq/L. Diagnosis of low serum potassium occurred, on average, after 5.1 months of individualized therapy. Multivariate analysis of risk factors for this adverse reaction identified two causes: administration of capreomycin, and low initial body weight. Normalization of potassium levels was achieved in 86% of patients.

Conclusions: Electrolyte disturbance was frequently encountered in our cohort of patients with MDR-TB. Successful screening and management of hypokalemia was facilitated by training the health-care team in the use of a standardized algorithm. Morbidity from hypokalemia can be significant; however, effective management of this side effect is possible without sacrificing MDR-TB treatment efficacy.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antitubercular Agents / administration & dosage
  • Antitubercular Agents / adverse effects*
  • Capreomycin / adverse effects
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hypokalemia / chemically induced*
  • Magnesium / blood
  • Male
  • Multivariate Analysis
  • Retrospective Studies
  • Risk Factors
  • Tuberculosis, Multidrug-Resistant / blood
  • Tuberculosis, Multidrug-Resistant / drug therapy*


  • Antitubercular Agents
  • Capreomycin
  • Magnesium