More severe hyponatraemia may require fluid restriction in the short term as well as withdrawal of the causal drug. Hyponatremia is usually defined as a plasma sodium level hyponatremia results from the inability of the kidney to excrete a sufficient amount of fluid, or is due to excessive fluid intake. Glycineinduced hypoosmolar hyponatremia jama internal. Nov 15, 20 pharmacists also play an important role in recognizing which drugs cause euvolemic hyponatremia induced by siadh see table 1.
Drug induced hyponatremia can be caused by a variety of drugs and can reach an incidence of 514% 4. A variety of pharmacological agents a variety of pharmacological agents affect glucose homeostasis resulting in either hypo or hyperglycemia. Druginduced syndrome of inappropriate antidiuretic hormone. Hormones such as insulin, glucagon, catecholamines, growth hormone, and cortisol, among others, contribute to normoglycemia. They also presented rare causes of drug induced hyponatremia derived from occasionally reported cases. Hyponatremia defined as a serum sodium level hyponatremia. May 23, 2020 hyponatremia occurs when the concentration of sodium in your blood is abnormally low. Carbamazepine and hyponatremia in patients with affective disorder. Treatment of chronic asymptomatic hyponatremia induced by siadh. In clinical practice, hypernatraemia serum sodium higher than 145 mmoll is usually of multifactorial aetiology and drug therapy not infrequently is disregarded as a contributing factor for increased serum.
Listed below are some drugs that may cause hyponatraemia serum sodium concentration below 5 mmoll angiotensinconverting enzyme inhibitors ace inhibitors. Polypharmacy is highly prevalent in older people and many drugs can cause hyponatremia as a collateral effect. Most patients with drug induced hyponatraemia are asymptomatic and the. Hyponatremia defined as a serum sodium level mmoll is the most commonelectrolyte abnormality in hospitalized patients. He has had a little bit of swelling around his ankles lately as well as his blood pressure being a little elevated. There are certainly lots of factors that can cause hyponatremia, but there are definitely a few medications you need to look out for. About a series of 54 cases notified to the reginal center of pharmacovigilance of saintetienne. However, the united states food and drug administration. Druginduced hyponatraemia in psychogenic polydipsia.
Hyponatremia defined as a serum sodium level drug induced hyponatraemia. Drug induced electrolyte abnormalities have been increasingly reported and may be associated with considerable morbidity andor mortality. All individual adverse drug reactions adr reported to mpa from 1 january 2010 to 31 october 20 of suspected druginduced hyponatremia and random controls were identified. Although hypokalemia defined as a low serum potassium concentration usually reflects total body intracellular potassium depletion, it can exist in the absence of external losses, due either to abrupt shifts in extracellular ph or glucose concentration. Drug induced serum glucose alterations manifested as hyperglycemia or hypoglycemia can have perpetual effects on the body. Eleven patients with thiazide induced kaluril hydrochlorothiazide, 50 mg.
Drug induced hyponatremia has been widely observed. In our retrospective analysis of geriatric medical records dated 2015 we found that. Severe hyponatremia serum na, 91 to 120 meqliter secondary to the use of diuretics was observed in 25 nonedematous patients with clinically normal hydration and creatinine clearances. A search was carried out in the medline and embase databases from january 1966 to 11 april 2009.
Fulltext pdf in reply to druginduced hyponatremia adding to the list and tramadolinduced hyponatremia. Diuretics make up one of the most common causes of hyponatremia, with an estimated incidence of 11% in 1 series of 114 geriatric patients. Hyponatremia, defined as serum sodium concentrations. Jan 24, 2018 here i present a scenario of a likely multifactorial situation of drug induced hyponatremia. George liamis, md, haralampos milionis, md, and moses elisaf, md.
Certain drugs eg, diuretics,antidepressants, and antiepileptics have been implicated as established causesof either asymptomatic or symptomatic hyponatremia. Acute cases, or those with severe or refractory not. Selfinduced water intoxication without predisposing illness. In this article, we focus on 3 classes of psychotropics, and their role in causing siadh. Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. Management of hyponatremia american family physician. Blijderveen jc, straus sm, rodenburg em, zietse r, stricker bh, et al. A 50yearold woman was admitted to hospital complaining of nausea, diarrhoea and abdominal pain. However, since it may be clinically symptomatic or asymptomatic, it is frequently. Sep 26, 2007 drug induced hyponatremia is generally asymptomatic, so it is usually diagnosed incidentally after routine blood tests.
Psychotropic drugs such as antidepressants, antipsychotics, mood stabilizers, and sedative hypnotics. Aug 20, 2014 a number of medications have been proposed as possible causes of drug induced urinary incontinence, including alpha 1adrenoceptor antagonists, antipsychotics, benzodiazepines, antidepressants, and drugs used for hormone replacement therapy. The sodium level increased from 122 to m m within 2 days of discontinuation of cbz. Sequential druginduced severe hyponatremia in a minimally. Avoid common mistakes when treating hyponatremia acp. Sodium is an electrolyte, and it helps regulate the amount of water thats in and around your cells. Druginduced hyponatremia can be caused by a variety of drugs and can reach an incidence of 514% 4. Psychotropicinduced hyponatremia mdedge psychiatry.
It may have serious consequences in asyntomatic patients with a mild disease. Increased risk of druginduced hyponatremia during high. Syncope related to the use of quinidine was first described in the 1920s. Mar 01, 2015 hyponatremia is a common electrolyte disorder defined as a serum sodium level of less than 5 meq per l. Drugs are a common cause of electrolyte abnormalities, and a careful drug history is essential in patients in whom these are demonstrated. Hyponatremia defined as a serum sodium level drugs eg, diuretics, antidepressants, and antiepileptics have been implicated as established causes of either asymptomatic or symptomatic hyponatremia. Most of the data for drug induced siadh come from case reports and small case series, such as those described in table 2.
A 69 year old male has a past medication history of epilepsy, depression, diabetes, and hypertension. More severe cases may additionally require shortterm fluid restriction. The present patient took a particular formulation of mk different from the standard mk. In recent years, several pharmacologic agents have been shown to have waterretaining properties. Most patients with druginduced hyponatraemia are asymptomatic and the diagnosis is made incidentally following routine blood tests. May 15, 2004 medications and drugs that cause hyponatremia are listed in table 1. Antimicrobials induced hyponatremia in elderly patients. One of the more common electrolyte abnormalities that may be drug induced is hyponatremia. Drug induced hyponatremia is a topic i come across every once in a while. Druginduced syndrome of inappropriate antidiuretic. Tolvaptan and conivaptan, but not lixivaptan, are approved for use in the united states.
In hyponatremia, one or more factors ranging from an underlying medical condition to drinking too much water cause the sodium in your body to become. In mild cases, it may be sufficient to withdraw the drug and keep the patient under observation. Jun 25, 2019 hyponatremia is the most common electrolyte disorder. It can be induced by a marked increase in water intake primary polydipsia andor by impaired water excretion due, for example, to advanced renal failure or persistent release of antidiuretic hormone adh. However, many drugs were not included in the investigators. Most patients with drug induced hyponatraemia are asymptomatic and the diagnosis is made. Physicians may not always give proper attention in time to undesirable drug induced hyponatremia. Mechanism of chlorpropamideinduced antidiuresis in man. The incidence of thiazideinduced hyponatremia has not been. Drugs affecting sodium and water homeostasis diuretic treatment. Certain drugs eg, diuretics, antidepressants, and antiepileptics. Hyponatremia in elderly subjects is mainly caused by drugs more frequently. Managing druginduced hyponatraemia in adults australian. Druginduced hypokalemia jama pediatrics jama network.
Her medical history included depression, alcoholism and laryngeal. Diuretics are usually the first class of drugs that i think about that have an impact on lots of electrolytes. Alcohol and ecstasy use are relevant factors in the social history, while thiazides and selective serotonin reuptake inhibitors can cause drug induced hyponatremia, which is often overlooked, she and other experts noted. Hyponatremia associated with repeated use of levetiracetam. Later, the hyponatremia became unresponsive to aggressive treatment in spite of cbz discontinuation. Initially, the cause of this syncope was not understood, but in the 1960s, a drugrelated, pausedependent form of polymorphic ventricular tachycardia was identified by selzer and wray. As most of the available data are derived from case reports and small case series, the distribution of the different medication classes as siadh aetiologies is unknown.
Susceptibilty of the elderly patient to hyponatremia induced by selective serotonin reuptake inhibitors. At first, the antidiuretic actions were used to advantage in the treatment of patients with diabete. One of the more common electrolyte abnormalities that may be drug induced is hyponatraemia. Drug induced hyponatraemia is commonly associated with diuretics, selective serotonin reuptake inhibitors and antiepileptics. To investigate the relationship between outdoor temperature in sweden and the reporting of druginduced hyponatremia to the medical products agency mpa. Diuretic induced hyponatremia and sustained antidiuresis. Hyponatremia represents a relative excess of water in relation to sodium. Therefore, an evaluation of unsual causes is of paramount importance. Hyponatremia during carbamazepine therapy in patients with intellectual disability. However, hyponatremia occasionally may develop in the course of treatment with drugs used in everyday clinical practice eg, newer antihypertensive agents, antibiotics, and proton pump inhibitors.
1231 1640 184 1555 374 1181 17 902 938 781 1200 1208 1040 1615 16 247 791 1490 1542 969 1259 944 1115 100 256 574 1138 1167 1507 1406 1364 1444 1252 166 445 215 966 306 664 369 461 1238