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

Table 1 Characteristics at baseline, before and during nafamostat mesylate administration

	Patient
Baseline	1	2	3	4
Age (yr)	63	58	54	60
Gender	Male	Female	Male	Female
Height (m)	1.67	1.5	1.78	1.52
Weight (kg)	75	60	78.6	56
Comorbidity
Diabetes mellitus	-	-	+	-
Hypertension	-	+	-	-
Chronic kidney disease	-	-	-	-
Cardiovascular disease	-	-	-	-
Before NM initiation
Laboratory data at NM initiation
WBC (/L)	11.02 × 109	9.92 × 109	6.93 × 109	4.2 × 109
Lym (%)	18.8	8.3	9.5	12.8
Hb (g/dL)	10.2	11.2	12.4	12.9
PLT (/L)	345 × 109	465 × 109	129 × 109	222 × 109
Lactate (mmol/L)	1.33	0.97	1.85	0.55
CRP (mg/dL)	5.99	9.71	16.41	10.33
AST (IU/L)	110	116	50	52
ALT (IU/L)	197	174	26	24
LDH (IU/L)	403	469	678	611
UN (mg/dL)	17	21	30	6
Cre (mg/dL)	0.61	0.6	0.98	0.4
APTT (s)	35.0	56.1	49.4	32.8
PT-INR	0.97	1.23	1.22	1.05
FDP (mcg/mL)	19.9	21.0	6.6	5.0
FDP-DD (mcg/mL)	9.5	10.7	2.2	1.4
Fbg (mg/dL)	578	605	531	484
p/f	233	200	146	196
Physical sign
Systolic blood pressure (mmHg)	169	167	102	196
Diastolic blood pressure (mmHg)	80	75	53	108
Heart rate (/min)	117	95	118	82
Respiratory rate (/min)	29	20	18	15
Body temperature (°C)	37.1	37.7	38.7	37.2
SOFA score	3	2	6	3
Support
Respiratory support	IMV	IMV	IMV	IMV
Prone position	+	+	-	-
VV-ECMO	-	-	+	+
During NM administration
NM [mg/(kg·h)]	0.13	0.14	0.15	0.14
Medication	Favipiravir, Dalteparin, Esomeprazole, Dexmedetomedine, Suvorexant, Ramelteon, Bromhexine, Mosapride	Favipiravir, Dalteparin, Esomeprazole, Suvorexant, Ramelteon, Pitavastatin, Amlodipine, Azilsartane	Dalteparin, Omeprazole, Dexmedetomedine, Propofol, Fentanyl, Midazolam, Bromhexine, Rocuronium, Noradrenaline, CTRX, AZM	Favipiravir, Esomeprazole, Omeprazole, Dexmedetomedine, Propofol, Fentanyl, Nardemedine
Intervention
K-intake decrease	-	+	-	+
Furosemide	-	-	-	+
Glucose-Insulin therapy	-	-	+	-
K net
K-intake [mEq/(kg·d)]	0.90	1.07	0.34	0.81
K-out (mEq/d)		49.8	8.7	16.5
K-balance (mEq/d)		7.8	31.3	51.5

WBC: White blood cell; Lym: Lymphocytes; Hb: Hemoglobin; PLT: Platelet; CRP: C-reactive protein; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; LDH: Lactate dehydrogenase; UN: Urea nitrogen; Cre: Creatinine; APTT: Activated partial thromboplastin time; PT-INR: Prothrombin time and normalized ratio; FDP: Fibrin degradation products; FDP-DD: Fibrin degradation product D-dimer; Fbg: Fibrinogen; p/f: PaO2/FiO2; SOFA: Sequential organ failure assessment; VV-ECMO: Veno-venous extracorporeal membrane oxygenation; NM: Nafamostat mesylate; K: Potassium.