Ticarcillin associated hypokalemia

We evaluated the presence and degree of hypokalemia associated with ticarcillin disodium (ticarcillin) therapy in 16 patients. Four of these patients who received less than 10 grams of ticarcillin did not develop significant hypokalemia, but his condition developed in 6 of 9 patients receiving a daily dose of greater than 18 grams of this drug, and the mean urinary potassium was elevated in this group (mean=78 mEq/24 hrs). The degree of hypokalemia was correlated with the volume status of the patient as judged by the serum urea nitrogen: creatinine ratio. A positive correlation (r=0.66, p<0.05) was obtained between the two parameters. Hypokalemia did not develop in three patients with the syndrome of inappropriate secretion of anti-diuretic hormone who were receiving more than 18 grams of ticarcillin daily, indicating the absence of a stimulus for sodium conservation. Aggressive potassium and fluid replacement should be considered in patients with hypokalemia associated with ticarcillin therapy.