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Co-trimoxazole is a
combination antibiotic made up of trimethoprim and sulphamethoxazole that is
first line treatment for Pneumocystis
jirovecii pneumonia (PJP). Hyperkalaemia is a relatively common side effect
of the trimethoprim component of co-trimoxazole but it is not well recognised
by clinicians. The mechanism of action causing hyperkalaemia due to
trimethoprim is similar to the potassium sparing diuretic effect of amiloride.
It has been suggested on this basis that the hyperkalaemia can be reversed by
the administration of furosemide and 0.9% saline to promote kaliuresis. We
present what we believe to be the first published case of successfully managing
trimethoprim induced hyperkalaemia with furosemide and 0.9% saline allowing the
continued use of co-trimoxazole to treat severe PJP.