Hiperkalemia yang Disebabkan oleh Siklosporin pada Pasien Myelodysplastic Syndrome (MDS)
DOI:
https://doi.org/10.36408/mhjcm.v9i1.706Keywords:
siklosporin, hiperkalemia, myelodysplastic syndromeAbstract
Latar belakang: Siklosporin merupakan calcineurin inhibitor yang dapat digunakan sebagai imunosupresan pada myelodysplastic syndrome (MDS). Hiperkalemia adalah salah satu efek samping siklosporin. Kejadian hiperkalemia dari penggunaan siklosporin belum banyak dilaporkan. Meskipun jarang disertai dengan gejala, hiperkalemia sedang dan berat dapat menjadi fatal dan mengancam jiwa.
Tujuan: Menjelaskan secara rinci mengenai hiperkalemia yang disebabkan oleh siklosporin pada pasien MDS serta penatalaksanaannya.
Kasus: Seorang laki-laki (74 tahun) datang dengan keluhan melena, lemas, batuk berdahak. Pasien memiliki riwayat MDS, hipertensi, Chronic Kidney Disease (CKD), dan diabetes mellitus dan rutin minum obat siklosporin, irbesartan, dan spironolakton. Pasien mengalami hiperkalemia sejak awal masuk rumah sakit (kalium 7,8 mmol/L). Selama rawat inap, spironolakton dihentikan, irbesartan dan siklosporin dilanjutkan. Untuk terapi hiperkalemia, pasien menerima infus insulin-dekstrose dan kalsium polistirena sulfonat namun kadar kalium masih tinggi. Kalium turun ke nilai normal (4,4 mmol/L) setelah siklosporin dihentikan pada hari ke-8.
Diskusi: Beberapa faktor pemicu hiperkalemia (CKD, diabetes mellitus, penggunaan bersama obat siklosporin, spironolakton, dan irbesartan) menyebabkan penanganan hiperkalemia cukup sulit. Siklosporin menyebabkan hiperkalemia melalui beberapa mekanisme yang berbeda sehingga pengaruhnya cukup kuat. Strategi penatalaksanaan hiperkalemia pada pasien ini meliputi penghentian spironolakton, pemberian insulin-dekstrose dan kalsium polistirena sulfonat, diikuti penghentian obat siklosporin.
Kesimpulan: Siklosporin dapat menyebabkan hiperkalemia, sehingga penting untuk melakukan pemantauan kadar kalium secara rutin terutama bila siklosporin diberikan bersama dengan obat lain atau pada kondisi yang dapat meningkatkan kadar kalium.
Kata kunci: siklosporin, hiperkalemia, myelodysplastic syndrome
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