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Case Reports
. 2020 Nov 6;8(21):5320-5325.
doi: 10.12998/wjcc.v8.i21.5320.

Nafamostat mesylate-induced hyperkalemia in critically ill patients with COVID-19: Four case reports

Masaki Okajima  1 , Yoshinori Takahashi  2 , Takaaki Kaji  3 , Naohiko Ogawa  4 , Hideyuki Mouri  5
Affiliations
Case Reports

Nafamostat mesylate-induced hyperkalemia in critically ill patients with COVID-19: Four case reports

Masaki Okajima et al. World J Clin Cases. .

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.

Keywords: COVID-19; Case report; Disseminated intravascular coagulation; Hyperkalemia; Nafamostat; Respiratory insufficiency.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Changes in serum potassium and creatinine levels before and during nafamostat mesylate administration. Serum potassium levels increased in all four patients on the third day of NM administration without acute kidney disease. A: Serum potassium; B: Serum creatinine. Cre: Creatinine; NM: Nafamostat mesylate; K: Potassium.
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