Drug induced hyponatremia pdf

One of the more common electrolyte abnormalities that may be drug induced is hyponatraemia. The present patient took a particular formulation of mk different from the standard mk. Management of hyponatremia american family physician. 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. Sep 26, 2007 drug induced hyponatremia is generally asymptomatic, so it is usually diagnosed incidentally after routine blood tests. Diuretics make up one of the most common causes of hyponatremia, with an estimated incidence of 11% in 1 series of 114 geriatric patients. A variety of pharmacological agents a variety of pharmacological agents affect glucose homeostasis resulting in either hypo or hyperglycemia. With increasing polypharmacy and an ageing population, the prevalence of drug induced hyponatraemia is likely to increase. Druginduced syndrome of inappropriate antidiuretic. Psychotropic drugs such as antidepressants, antipsychotics, mood stabilizers, and sedative hypnotics. 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. Drugs are a common cause of electrolyte abnormalities, and a careful drug history is essential in patients with electrolyte abnormalities. Syncope related to the use of quinidine was first described in the 1920s.

Certain drugs eg, diuretics, antidepressants, and antiepileptics. Susceptibilty of the elderly patient to hyponatremia induced by selective serotonin reuptake inhibitors. May 15, 2004 medications and drugs that cause hyponatremia are listed in table 1. Sodium is an electrolyte, and it helps regulate the amount of water thats in and around your cells. In this article, we focus on 3 classes of psychotropics, and their role in causing siadh. In our retrospective analysis of geriatric medical records dated 2015 we found that.

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. The sodium level increased from 122 to m m within 2 days of discontinuation of cbz. Most patients with drug induced hyponatraemia are asymptomatic and the diagnosis is made. There are certainly lots of factors that can cause hyponatremia, but there are definitely a few medications you need to look out for. Jan 24, 2018 here i present a scenario of a likely multifactorial situation of drug induced hyponatremia. 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. Polypharmacy is highly prevalent in older people and many drugs can cause hyponatremia as a collateral effect. May 23, 2020 hyponatremia occurs when the concentration of sodium in your blood is abnormally low. Mar 01, 2015 hyponatremia is a common electrolyte disorder defined as a serum sodium level of less than 5 meq per l. Listed below are some drugs that may cause hyponatraemia serum sodium concentration below 5 mmoll angiotensinconverting enzyme inhibitors ace inhibitors. Druginduced hypokalemia jama pediatrics jama network. Therefore, an evaluation of unsual causes is of paramount importance. Hyponatremia, defined as serum sodium concentrations. Most patients with druginduced hyponatraemia are asymptomatic and the diagnosis is made incidentally following routine blood tests.

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. Selfinduced water intoxication without predisposing illness. Later, the hyponatremia became unresponsive to aggressive treatment in spite of cbz discontinuation. Hyponatremia defined as a serum sodium level hyponatremia. A search was carried out in the medline and embase databases from january 1966 to 11 april 2009. Increased risk of druginduced hyponatremia during high. Drug induced electrolyte abnormalities have been increasingly reported and may be associated with considerable morbidity andor mortality. However, the united states food and drug administration.

Drug induced hyponatraemia is commonly associated with diuretics, selective serotonin reuptake inhibitors and antiepileptics. 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. Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. Eleven patients with thiazide induced kaluril hydrochlorothiazide, 50 mg. Hyponatremia defined as a serum sodium level mmoll is the most commonelectrolyte abnormality in hospitalized patients. In mild cases, it may be sufficient to withdraw the drug and keep the patient under observation. Hyponatremia in the syndrome of inappropriate antidiuretic hormone secretion siadh results from adhinduced retention of ingested or infused water.

Hyponatremia associated with repeated use of levetiracetam. Sequential druginduced severe hyponatremia in a minimally. He has had a little bit of swelling around his ankles lately as well as his blood pressure being a little elevated. 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. It may have serious consequences in asyntomatic patients with a mild disease. One common family of medications that can cause medicationinduced hyponatremia is thiazide di uretics, which can induce hyponatremia within 2 weeks of. Diuretics are usually the first class of drugs that i think about that have an impact on lots of electrolytes. Tolvaptan and conivaptan, but not lixivaptan, are approved for use in the united states. Druginduced syndrome of inappropriate antidiuretic hormone. Certain drugs eg, diuretics,antidepressants, and antiepileptics have been implicated as established causesof 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.

Drugs affecting sodium and water homeostasis diuretic treatment. Most patients with drug induced hyponatraemia are asymptomatic and the. Drug induced serum glucose alterations manifested as hyperglycemia or hypoglycemia can have perpetual effects on the body. Diuretic induced hyponatremia and sustained antidiuresis. Nov 15, 20 pharmacists also play an important role in recognizing which drugs cause euvolemic hyponatremia induced by siadh see table 1. Herein, we pro vide an overview of culprit medications that may adversely affect sodium levels and cause hyponatremia. At first, the antidiuretic actions were used to advantage in the treatment of patients with diabete. Carbamazepine and hyponatremia in patients with affective disorder. 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. Treatment of chronic asymptomatic hyponatremia induced by siadh. Antimicrobials induced hyponatremia in elderly patients. Mechanism of chlorpropamideinduced antidiuresis in man. Glycineinduced hypoosmolar hyponatremia jama internal. 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.

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. Her medical history included depression, alcoholism and laryngeal. Avoid common mistakes when treating hyponatremia acp. They also presented rare causes of drug induced hyponatremia derived from occasionally reported cases. Drug induced hyponatremia can be caused by a variety of drugs and can reach an incidence of 514% 4. However, hyponatremia occasionally may develop in the course of treatment with drugs used in everyday. Hyponatremia in elderly subjects is mainly caused by drugs more frequently. Jun 25, 2019 hyponatremia is the most common electrolyte disorder.

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. Hormones such as insulin, glucagon, catecholamines, growth hormone, and cortisol, among others, contribute to normoglycemia. Drugs are a common cause of electrolyte abnormalities, and a careful drug history is essential in patients in whom these are demonstrated. George liamis, md, haralampos milionis, md, and moses elisaf, md. Drug induced hyponatremia has been widely observed. Physicians may not always give proper attention in time to undesirable drug induced hyponatremia. Hyponatremia represents a relative excess of water in relation to sodium. In recent years, several pharmacologic agents have been shown to have waterretaining properties. Hyponatremia defined as a serum sodium level drug induced hyponatraemia. Drug induced hyponatremia is a topic i come across every once in a while. Blijderveen jc, straus sm, rodenburg em, zietse r, stricker bh, et al. Psychotropicinduced hyponatremia mdedge psychiatry. Fulltext pdf in reply to druginduced hyponatremia adding to the list and tramadolinduced hyponatremia. More severe cases may additionally require shortterm fluid restriction.

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. More severe hyponatraemia may require fluid restriction in the short term as well as withdrawal of the causal drug. However, many drugs were not included in the investigators. To investigate the relationship between outdoor temperature in sweden and the reporting of druginduced hyponatremia to the medical products agency mpa. Managing druginduced hyponatraemia in adults australian. Druginduced hyponatremia can be caused by a variety of drugs and can reach an incidence of 514% 4. Mild cases may be managed either by stopping the drug or by careful observation if the drug is considered essential. 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. Druginduced hyponatraemia in psychogenic polydipsia. Diureticinduced hyponatremia annals of internal medicine. A 50yearold woman was admitted to hospital complaining of nausea, diarrhoea and abdominal pain.

Hyponatremia during carbamazepine therapy in patients with intellectual disability. One of the more common electrolyte abnormalities that may be drug induced is hyponatremia. About resourcepharm advertise contact us terms and conditions. Certain drugs eg, diuretics, antidepressants, and antiepileptics have been implicated as established causes of either asymptomatic or symptomatic hyponatremia. The incidence of thiazideinduced hyponatremia has not been. Acute cases, or those with severe or refractory not. A 69 year old male has a past medication history of epilepsy, depression, diabetes, and hypertension.