Okajima M, Takahashi Y, Kaji T, Ogawa N, Mouri H. Nafamostat mesylate-induced hyperkalemia in critically ill patients with COVID-19: Four case reports. World J Clin Cases 2020; 8(21): 5320-5325 [PMID: 33269265 DOI: 10.12998/wjcc.v8.i21.5320]
Corresponding Author of This Article
Masaki Okajima, MD, PhD, Assistant Professor, Intensive Care Unit, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan. mmokaji@gmail.com
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Masaki Okajima, Hideyuki Mouri, Intensive Care Unit, Kanazawa University Hospital, Kanazawa 920-8641, Ishikawa, Japan
Yoshinori Takahashi, Department of Rheumatology, Kanazawa University Hospital, Kanazawa 920-8641, Ishikawa, Japan
Takaaki Kaji, Department of Nephrology, Kanazawa University Hospital, Kanazawa 920-8641, Ishikawa, Japan
Naohiko Ogawa, Department of Respiratory Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Ishikawa, Japan
Author contributions: Okajima M and Mouri H designed the study, had full access to all the study data, and take responsibility for the integrity and accuracy of the data; Kaji T contributed to data collection and analyzed the mechanism of hyperkalemia; Ogawa N played a role in managing treatment using nafamostat mesylate; Takahashi Y supervised this study and contributed to the writing of the manuscript; all authors contributed to data acquisition, data analysis, or data interpretation and approved the final version of the manuscript.
Informed consent statement: This case series was approved by the Institutional Review Board of the University of Kanazawa, No. 3438. All the reported individuals provided consent to participate in accordance with the Declaration of Helsinki.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masaki Okajima, MD, PhD, Assistant Professor, Intensive Care Unit, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan. mmokaji@gmail.com
Received: September 10, 2020 Peer-review started: September 10, 2020 First decision: September 23, 2020 Revised: October 1, 2020 Accepted: October 20, 2020 Article in press: October 20, 2020 Published online: November 6, 2020
Abstract
BACKGROUND
Nafamostat mesylate (NM) may prove to be one of the key drugs effective against coronavirus disease 2019 (COVID-19) because of its anti-viral properties and the potential to manage coagulopathy. However, NM tends to increase serum potassium levels.
CASE SUMMARY
We observed hyperkalemia immediately after NM administration (200 mg/d) in four consecutive patients who were admitted to the Kanazawa University Hospital with severe COVID-19 pneumonia. Urinary potassium excretion decreased after NM administration in three patients who underwent urinalysis.
CONCLUSION
NM is likely to produce hyperkalemia in patients with COVID-19. Therefore, it is necessary to monitor serum potassium values closely after NM initiation in COVID-19 patients who need respiratory support.
Core Tip: The coronavirus disease 2019 (COVID-19) pandemic is a rapidly evolving situation. Nafamostat mesylate (NM) may prove to effective against COVID-19. However, our case series shows NM-induced hyperkalemia in 4 patients with COVID-19. Monitoring serum potassium levels after NM-initiation is imperative.
