Nephrogenic diabetes insipidus associated with foscarnet treatment of cytomegalovirus retinitis
Article Abstract:
Diabetes insipidus is a metabolic disorder characterized by extreme increases in the volume of urine excreted, and volume of water taken in. This condition results either from a decreased production of antidiuretic hormone (ADH) by the pituitary gland of the brain, or by the inability of ADH to act on the kidney tubules, which regulates the amount of urine excreted. The latter is called "nephrogenic diabetes insipidus " and can result either from a genetic disorder, or as a consequence of drug therapy. Patients with the acquired immunodeficiency syndrome (AIDS) frequently develop infections with the cytomegalovirus (CMV), which can cause inflammation of the retina and eventually blindness. A recent clinical report describes a 37 year old homosexual man who was hospitalized at a San Francisco hospital for evaluation because he complained of excessive thirst and urination. A few years earlier, he had been diagnosed with AIDS after developing Kaposi's sarcoma, a rare type of skin cancer, and since then, he had been hospitalized three times with Pneumocystis carinii pneumonia. Eleven months earlier, he had developed CMV retinitis and despite treatment with an antiviral drug, the retinitis worsened. At this point he was put on an investigational drug called foscarnet, which is similar in chemical structure to pyrophosphate. Toxicity to the kidneys is the most frequent side effect of foscarnet therapy and no other cause for diabetes insipidus could be found in this patient. The mechanism by which foscarnet causes diabetes insipidus is not known but may involve an action on the collecting ducts of the kidney, which are the sites where water is reabsorbed back into the body. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1990
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Acetaminophen does not impair clearance of zidovudine
Article Abstract:
People who are infected with the human immunodeficiency virus (HIV), the agent that causes AIDS, are often treated with the drug zidovudine, which has been shown to decrease mortality and decrease the number of infections that develop. Zidovudine has several side effects, including anemia and low white blood cell counts. Some reports have suggested that the drug acetaminophen can potentiate these adverse effects of zidovudine. Acetaminophen is a commonly used pain reliever and fever medication. A group of 27 patients with HIV infection who were taking zidovudine were studied. They were given various doses of acetaminophen simultaneously with zidovudine, and then had multiple blood samples drawn to measure the level of zidovudine in their bloodstreams. Elevated blood levels of zidovudine would have provided indirect evidence that acetaminophen could worsen its toxic effects. Interestingly, the blood levels of zidovudine measured were lower after administration of acetaminophen than before, suggesting that there should be no increased toxicity in using the two drugs simultaneously. Indeed, in the short time that these patients were observed, there was no increased toxicity noted in using the two drugs. Based on these results it is concluded that patients taking zidovudine can probably use acetaminophen safely. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1991
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