Severe hyponatremia as a result of thiazide diuretic. Thiazide diuretics are among the most common antihypertensive medications prescribed, and their use is likely to increase in the near future based upon the results of the allhat study. Apr 10, 2018 hypertension affects more than 30% of the worlds adult population and thiazide and thiazidelike diuretics are amongst the most widely used, effective, and least costly treatments available, with allcause mortality benefits equivalent to angiotensinconverting enzyme inhibitors or calcium channel antagonists. A loop diuretic is much less likely to induce this problem unless the diuretic has induced volume depletion or water intake is very high since loop diuretics partially impair urinary. Adh secretion or an element of renal impairment limiting the maximal excretion of free water. This document contains side effect information about hydralazine hydrochlorothiazide. Most patients with drug induced hyponatraemia are asymptomatic and the. Hyponatremia develops when the body is unable to excrete free water. Risk of thiazideinduced hyponatremia in patients with. Hyponatremia was induced over three days with dglucose in water and vasopressin. Virtually all cases of severe diuretic induced hyponatremia have been due to a thiazide type diuretic. The importance of thiazide induced hyponatremia tih is reemerging because thiazide diuretic prescription seems to be increasing after the guidelines recommending thiazides as firstline treatment of essential hypertension have been introduced. Hyponatremia is often found in the early stages of diuretic therapy17,18.
Severe hyponatremia associated with the combined use of. Patients with thiazide induced hyponatremia are at high risk for a recurrence and should not be rechallenged with a thiazide. Druginduced hyponatraemia is commonly associated with diuretics, selective serotonin reuptake inhibitors and antiepileptics. Prospective controlled study comparing patients with previous thiazide induced hyponatremia with two control groups.
Thiazide induced hyponatremia, a detailed phenotypic and. Thiazideinduced hyponatremia associated with death or. Thiazide induced hyponatremia is this weeks version of spooky sodium. Factors influencing thiazides induced reduction in sna are extensively described in light of thiazide induced hyponatremia and include impairment of free water clearance and excessive anti. Hyponatremia, defined as serum sodium concentrations induced hyponatremia has been widely observed. Hyponatremia, defined as serum sodium concentrations duced hyponatremia is related to the reduction in the renal free water clearance. Severe hyponatremia can cause an osmotic transfer of water from the plasma into the brain cells. However, hyponatremia occasionally may develop in the course of treatment with drugs used in everyday. Medline abstracts for references 17 of diureticinduced. Blood glucose concentrations above 20 mmoll can therefore spuriously reduce the serum sodium. There are certainly lots of factors that can cause hyponatremia, but there are definitely a few medications you need to look out for. Hypertonic saline 3% nacl infusion until an increase of 46 mmoll in serum sodium concentration is achieved3,5. Severe hyponatremia associated with the use o f angiotensin.
The varied etiologies of hyponatremia and the multiple formulae for its correction. Diagnosis and treatment of hyponatremia inside the silver fridge. Hyponatremia in ckd population is associated with increased. Common finding of mild hyponatremia in children evaluated at the emergency department and its correlation with plasma creactive protein values. Thiazideinduced hyponatremia is predictable deepdyve. Moses s elisaf, md, department of internal medicine, school of medicine, university of ioannina, ioannina 45110, greece. Jun 30, 2010 hyponatremia is usually induced within 2 weeks of starting the thiazide diuretic, but it can occur any time during thiazide therapy when subsequent contributory factors are complicated, such as reduction of renal function with aging, ingestion of other drugs that affect free water clearance, or changes in water or sodium intake. With increasing polypharmacy and an ageing population, the prevalence of drug induced hyponatraemia is likely to increase. The onset of thiazide induced hyponatremia may in some cases occur within 1 day and therefore needs to be corrected rapidly, but within a total elevation of 20 meql in the first 24 h. In the present study, we analyzed differences in thiazide associated hyponatremia between men and women and between different categories of age, body mass index bmi, daily thiazide dose, and estimated glomerular filtration rate. Management of hyponatremia american family physician. Patients with thiazideinduced hyponatremia are usually or antidepressant drugs such as fluoxetine may also produce siadh in a few patients.
With increasing polypharmacy and an ageing population, the prevalence of druginduced hyponatraemia is likely to increase. The risk factors for the development of thiazideassociated hyponatremia are shown in table 1. Mineralocorticoid deficiency associated hyponatremia is chronic and responsds to 0. We read with interest the article of leung et al 1 evaluating the risk of diuretic induced hyponatremia in hypertensive patients. Hyponatremia is an occasional but potentially fatal complication of diuretic therapy. Sodium free irrigant solutions used in hysteroscopy, laparoscopy, or transurethral resection of. A minority of patients develop thiazideinduced hyponatremia tih and this is. Administer 3% hypertonic saline 100150cc iv over 510min 2. Sign up with your email address to receive a nevermorethanonceaweek. This is a singlearm, prospective, openlabel proofofconcept trial, including elderly patients with thiazide diureticinduced hyponatremia. Dec 01, 2017 remind me again why thiazide induced hyponatremia is categorized as volume depletion hyponatremia. Paroxetine is a selective serotonin reuptake inhibitor. Where the onset is judged to have been slow over several days, the level should be corrected at a slow rate, up to a total of 12 to 15 meql in 24 h.
Here, we have studied the phenotypic and genetic characteristics of patients hospitalized with tih. A loop diuretic is much less likely to induce this problem unless the diuretic has induced volume depletion 8 or water intake is very high since. Some of the dosage forms listed on this page may not apply to the brand name hydralazine plus applies to hydralazine hydrochlorothiazide. Agespecific incidence rate of hyponatremia per 100,000 person. When a euvolemic patient receiving a thiazide manifests hyponatremia, it should be termed thiazide associated hyponatremia tah. Hyponatremia is usually induced within 2 weeks of starting the thiazide diuretic, but it can occur any time during thiazide therapy when subsequent contributory factors are complicated, such as. Hyponatremia in emergency medicine differential diagnoses. Because furosemide induced diuresis is eq uiv alent to a onehalf isotonic saline s olution, it aids in the cor. Thiazide diuretics are the most commonly prescribed drug class, and in the united states alone more than 150 million prescriptions of hydrochlorothiazide are written every year. Son francisco, california from the nephrology section, department of medicine, veterans administration medical center and the university of california school of medicine, san francisco, california. Vasopres sin receptor antagonists, urea, and loop diuretics serve this purpose, but received. The salient mechanism for thiazidein duced hyponatremia is related to the reduction in the renal free water clearance. Forty patients will be enrolled and receive a bottle of a protein supplement daily, providing 120 mmol of solutes and permitting an extra 163 ml free water loss, for 4 weeks.
Because up to 20% of patients who receive 400 mg or more of hydralazine per. May 15, 2004 medications and drugs that cause hyponatremia are listed in table 1. Thiazideinduced hyponatremia is a common complication following thiazide treatment. Managing drug induced hyponatraemia in adults spiros fourlanos, fellow in endocrinology, royal melbourne hospital, and.
Nov 14, 2016 chronic kidney disease ckd is frequently complicated with hyponatremia, probably because of fluid overload or diuretic usage. Thiazideinduced syndrome of inappropriate secretion of. The importance of thiazideinduced hyponatremia tih is reemerging because thiazide diuretic prescription seems to be increasing after the guidelines recommending thiazides as firstline treatment of essential hypertension have been introduced. Virtually all cases of severe diuretic induced hyponatremia have been due to a thiazide type diuretic 17. At lower levels, overhydration water intoxication, an urgently dangerous condition, may result. Clinical and molecular features of thiazideinduced hyponatremia. The thiazide may be directly responsible box 1, termed thiazide induced hyponatremia by the hyponatremiaregistry,whichencompassesmorethan5,000 patients with serum sodium levels. Thiazide diureticcaused hyponatremia in the elderly. Jun 15, 2003 while cases of thiazide induced hyponatremia are well documented, this severity of hyponatremia is unusual. This pdf is available for free download from a site hosted by medknow publications.
Treat neurologic emergencies related to hyponatremia in the event of a seizure, coma or suspected cerebral herniation as a result of hyponatremia, iv 3% hypertonic saline should be administered as soon as possible according to the following guide. Antihypertensive therapy choice is a chief concern for family physicians. Certain drugs eg, diuretics, antidepressants, and antiepileptics. Thiazide diuretics are among the most widely used treatments for hypertension, but thiazideinduced hyponatremia tih, a clinically significant adverse effect, is poorly understood.
To determine whether a singledose of thiazide administered to patients with previous thiazide induced hyponatremia will cause hyponatremia and, if so, to analyze its pathogenesis. Diuretics are usually the first class of drugs that i think about that have an impact on lots of electrolytes. View fullsize tih patients during normonatremia still had a lower mean serum osmolarity compared to both control groups 288 mosmolkg compared to 295 mosmolkg and 293 mosmolkg. Clinical and genetic factors associated with thiazideinduced. Neurologic symptoms are typically present in cases of acute hyponatremia with serum sodium3. Drug induced hyponatraemia is commonly associated with diuretics, selective serotonin reuptake inhibitors and antiepileptics. Hyponatremia is usually induced within 2 weeks of starting the thiazide diuretic, but it can occur any time during thiazide therapy when subsequent contributory factors are complicated, such as reduction of renal function with aging, ingestion of other drugs that affect free water clearance, or changes in water or sodium intake.
First described in 1957 by schwartz and associates, 1 the syndrome of inappropriate secretion of antidiuretic hormone siadh has been recognized more frequently in recent years. Chronic kidney disease ckd is frequently complicated with hyponatremia, probably because of fluid overload or diuretic usage. Nov 15, 2018 hyponatremia is an occasional but potentially fatal complication of diuretic therapy. Drug induced hyponatremia is a topic i come across every once in a while. They also presented rare causes of drug induced hyponatremia derived from occasionally reported cases. In addition, potassium depletion and urinary salt loss have been postulated. Clinical studies thiazide induced hyponatremia associated with death or neurologic damage in outpatients nasim ashraf, m. Pantoprazole was discontinued and serum sodium levels reached normal values in two months. Sep 26, 2007 hyponatremia is an electrolyte disturbance characterized by a sodium concentration in the plasma below 5 mmoll. Hyponatremia defined as a serum sodium level hyponatremia. However, many drugs were not included in the investigators. Thiazides induced hyponatremia is usually chronic and should be corrected slowly as risk of ods is high.