Severe hypokalemia induced by ceftazidime-avibactam: Case report

RATIONALE: Ceftazidime-avibactam is widely used to treat infections caused by carbapenem-resistant Gram-negative bacteria. Although it is generally considered safe, cases of severe hypokalemia associated with its use have rarely been reported. PATIENT CONCERNS: A 74-year-old man with severe pneumonia and acute cerebral infarction was treated with ceftazidime-avibactam after sputum culture and nucleic acid testing identified multidrug-resistant Acinetobacter baumannii and Klebsiella pneumoniae. Soon after initiation of therapy, he developed persistent and refractory hypokalemia. DIAGNOSES: Drug-induced severe hypokalemia secondary to ceftazidime-avibactam was diagnosed. INTERVENTIONS: Antimicrobial therapy was continued, and the patient received oral spironolactone and nasogastric potassium chloride. Because of persistent hypokalemia and the development of acute kidney injury, the dose of ceftazidime-avibactam was reduced by half. After dose adjustment and continued potassium supplementation, serum potassium levels gradually stabilized. OUTCOME: The patient's condition worsened due to multiple organ failure and septic shock. At the request of his family, he was discharged against medical advice. LESSONS: This case suggests that avibactam may promote potassium loss by enhancing renal tubular secretion and increasing luminal electronegativity. Clinicians should be aware of this potential adverse effect, particularly in elderly patients or those with renal dysfunction. Close monitoring of serum and urinary potassium levels, along with early correction of abnormalities, is strongly recommended during treatment.