Liposomal amphotericin B-associated electrolyte abnormalities among adult patients in a tertiary hospital.

OBJECTIVES

To evaluate the possible electrolyte imbalances that can occur with the use of liposomal amphotericin B (L-AMB) among adult patients admitted to Sultan Qaboos University Hospital (SQUH).

METHODS

A retrospective observational study evaluating clinical characteristics, usage patterns, and electrolyte changes in 94 patients who received L-AMB during their admission at SQUH over 10 years (2015-2025).

RESULTS

The majority were male patients with cancer with a median age of 38.5 years, many presenting with sepsis and receiving empiric L-AMB therapy at an median dose of 5 mg/kg daily. Hydration prior to L-AMB initiation was common (74.5%), primarily using normal saline and dextrose. Treatment with L-AMB was associated with a significant decline in potassium and calcium and a rise in sodium levels.

CONCLUSION

L-AMB therapy is associated with significant and clinically meaningful electrolyte disturbances, most prominently progressive hypokalemia. Higher dose per kilogram and pre-infusion hydration were independently associated with hypokalemia. Patients with cancer present with lower baseline electrolytes and are at compounded risk. These findings reinforce the need for structured electrolyte monitoring protocols and early supplementation strategies in all patients receiving L-AMB, particularly those with malignancy or receiving higher drug doses.