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. Thiazide diureticcaused hyponatremia in the elderly. The salient mechanism for thiazideinduced hyponatremia is related to the reduction in the renal free water clearance. The salient mechanism for thiazidein duced hyponatremia is related to the reduction in the renal free water clearance. Rarely, such patients develop severe, lifethreatening hyponatremia within a few weeks after the initiation of a thiazide diuretic. However, some patients given thiazides develop thiazide induced hyponatremia tih 5. 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. Medline abstracts for references 17 of diureticinduced. The effect most responsible for thiazideinduced hyponatremia is the induced reduction of free water clearance by the kidneys.
Tih occur in up to 15% of treated adults and is one of the most common causes of severe hyponatremia in adults. 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. Thiazide induced hyponatremia associated with death or neurological damage in. Clinical studies thiazide induced hyponatremia associated with death or neurologic damage in outpatients nasim ashraf, m. 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. Sodium is an electrolyte, and it helps regulate the amount of water thats in and around your cells.
The risk factors for the development of thiazide associated hyponatremia are shown in table 1. Clinical and molecular features of thiazideinduced hyponatremia. 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. Managing drug induced hyponatraemia in adults spiros fourlanos, fellow in endocrinology, royal melbourne hospital, and peter greenberg, department of general medicine and department of diabetes and endocrinology, royal melbourne hospital, and university of melbourne department of medicine, royal melbourne hospital, melbourne synopsis. Hyponatremia defined as a serum sodium level hyponatremia. Thiazide diureticcaused hyponatremia in the elderly hypertensive.
Thiazideinduced hyponatremia associated with death or. The silent epidemic of thiazidea induced hyponatremia. Thiazide induced hyponatremia associated with death or neurologic damage in outpatients. Among the various causes of druginduced hyponatremia, thiazideinduced hyponatremia comprises a main cause, while loop diuretics only occasionally induce. As recently described by fichman et al and others, thiazideinduced hyponatremia may have the classic. Thiazideassociated hyponatremia, report of the hyponatremia.
Reproducibility by single dose rechallenge and an analysis of pathogenesis. Hyponatremia rhabdomyolysis thiazide diuretics creatine phosphokinase myoglobin myoglobinuria abstract background. Jun 15, 2003 severe hyponatremia as a result of thiazide diuretic. Hyponatremia in elderly subjects is mainly induced by medications more frequently thiazides and antidepressants, the syndrome of inappropriate antidiuretic hormone secretion siad or endocrinopathies. I cannot agree with the treatment regimen for diureticinduced hyponatremia advocated in the editorial by j. Managing druginduced hyponatraemia in adults spiros fourlanos, fellow in endocrinology, royal melbourne hospital, and. Limiting free water intake and increasing protein intake are often not. To examine whether a subgroup of patients is particularly susceptible to this complication. 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 the most frequent electrolyte disorder.
The management of hyponatremia norbert lameire, 2015. Antimicrobials induced hyponatremia in elderly patients. Thiazide diuretics inhibit the thiazide sensitive sodium chloride cotransporter ncc in the distal convoluted tubule dct of the kidney 3 and are among the most widely used class of medicines in the management of hypertension 4. The thiazide may be directly responsible, termed thiazideinduced hyponatremia by the hyponatremia registry, which encompasses more than 5,000 patients with serum sodium levels.
Tih occurs when the intake of free water is greater than the amount the. Interestingly tih is reproducible with drug rechallenge in some patients the hyponatremia can be induced with a single dose in susceptible patients. Hyponatremia is common with use of thiazides, begins soon after initiation of thiazides, may be severe and is common in elderly females. While cases of thiazideinduced hyponatremia are well documented, this severity of hyponatremia is unusual. Reporting dehydration with hypernatremia or hyponatremia requires two codes. Dec 01, 2017 of these, the mechanism of thiazide induced hyponatremia tih is poorly understood. Of these, 118 met criteria for true thiazideinduced hyponatremia tih. Neoplasms in rats treated with pituitary growth hormone.
Administration of thiazide diuretics also has been the cause of hyponatremia. Risk of thiazideinduced hyponatremia in patients with hypertension. This is a singlearm, prospective, openlabel proofofconcept trial, including elderly patients with thiazide diureticinduced hyponatremia. On the other hand, whether thiazideinduced severe hyponatremia without symptoms is more common in women than in men has not been proven. There was a high frequency of neurologic manifestation of thiazide induced hyponatremia, whereas clinical dehydration was not a discernible feature. Tih cases demonstrated an exaggerated free water reabsorption. 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. Thiazideinduced hyponatremia in the postoperative total joint replacement patient. Thiazideinduced hyponatremia associated with death or neurologic damage in outpatients. Two cohorts of patients who developed hyponatremia while using thiazide diuretics were analyzed. We report a case of duloxetineinduced hyponatremia in. Thiazideinduced syndrome of inappropriate secretion of. Thiazideinduced hyponatremia and vasopressin release. Here, we have studied the phenotypic and genetic characteristics of patients hospitalized with tih.
Read risk of thiazideinduced hyponatremia in patients with hypertension, the american journal of medicine on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Hyponatremia is an occasional but potentially fatal complication of diuretic therapy. When a euvolemic patient receiving a thiazide manifests hyponatremia, it should be termed thiazideassociated hyponatremia tah. Risk of thiazideinduced hyponatremia in patients with. Thiazideinduced hyponatraemia is common and potentially life threatening. Virtually all cases of severe diuretic induced hyponatremia have been due to a thiazide type diuretic. Jun 30, 2010 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 an uncommon, but serious, complication of diuretic therapy. Phenotypic and pharmacogenetic evaluation of patients with. The addition of thiazide diuretics to the metabolic milieu, with their. However, hyponatremia occasionally may develop in the course of treatment with drugs used in everyday. Hyponatremia represents a relative excess of water in relation to sodium.
Pdf the importance of thiazideinduced hyponatremia tih is reemerging. Overview of the treatment of hyponatremia in adults uptodate. When both dehydration and hyponatremia are documented, query the provider if the relationship between the dehydration and hyponatremia can be linked or be further specified. Thiazideinduced hyponatremia annals of internal medicine. Thiazideinduced hyponatremia in the postoperative total. This disorder may be present on admission to the intensive care setting or develop during hospitalization as a result of treatment or multiple comorbidities. Hence, tah occurs in a heterogeneous group of patients, and thiazides may not be directly responsible in all. Discovery of the molecular mechanism underlying thiazideinduced hyponatremia would guide the design of a more efficacious and tolerable antihypertensive agent. Severe hyponatremia as a result of thiazide diuretic.
Altered prostaglandin signaling as a cause of thiazideinduced. Discovery of the molecular mechanism underlying thiazide induced hyponatremia would guide the design of a more efficacious and tolerable antihypertensive agent. It is also surprising that the free water clearance was not more significantly reduced in the patients, an expected accompaniment when serum sodium is diluted. This is a particular problem in patients who despite a history of thiazide. Carlos ayus, md, in the july issue of the archives. However, hyponatremia rarely results from excessive water intake, unless the kidney is unabie to excrete free water, such as in patients on thiazide diuret. The risk factors for the development of thiazideassociated hyponatremia are shown in table 1.
This suggests that tih cases display an exaggerated increase in free water reabsorption in response to thiazide exposure. Hyponatremia and thiazides, journal of clinical hypertension. Clinical studies thiazideinduced hyponatremia associated with death or neurologic damage in outpatients nasim ashraf, m. Hyponatremia is the most frequently occurring electrolyte abnormality and can lead to lifethreatening complications. Thiazide induced hyponatremia in the postoperative total joint replacement patient. Thiazide diuretics are among the most widely used treatments for hypertension, but thiazideinduced hyponatremia tih, a clinically significant adverse effect, is poorly understood. Hyponatremia endocrine and metabolic disorders msd manual. In the absence of welldefined risk factors for this complication, guidelines for prescribing cannot be established. Water restriction in one patient attenuated serum sodium reduction.
With respect to the mechanisms of this hyponatremia, metolazone, a thiazide, was shown to turn a positive free water clearance into a negative one 78 x 78 ashraf, n. 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. Jci phenotypic and pharmacogenetic evaluation of patients. In addition, potassium depletion and urinary salt loss have been postulated to play a role in diureticinduced hyponatremia. Treatment of severe hyponatremia kidney international. Hyponatremia endocrine and metabolic disorders msd. Hyponatremia is one of the most common electrolyte abnormalities and is associated with many conditions. Thiazide induced hyponatremia, a detailed phenotypic and. Elderly patients may have increased sodium diuresis and are especially susceptible to thiazideinduced hyponatremia, particularly when they have a preexisting defect in renal capacity to excrete free water. Thiazide diuretics are among the most widely used treatments for hypertension, but thiazide induced hyponatremia tih, a clinically significant adverse effect, is poorly understood.
Eleven patients with thiazide induced kaluril hydrochlorothiazide, 50 mg. Thiazide induced hyponatremia, occurs due to increased water intake, reduction in diluting ability and water excretion in distal tubule. Reduced renal capacity to excrete free water, usually age. It has been reported in patients receiving diuretics as a physiological consequence of the therapy. Sodium disorders are associated with an increased risk. Although they ascribe the pathogenesis of thiazideinduced hyponatremia to excess drinking, they did not monitor water intake. A minority of patients develop thiazideinduced hyponatremia tih and this.
A minority of patients develop thiazideinduced hyponatremia tih and this is. Thiazide induced hyponatraemia is common and potentially life threatening. We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. A recent study by leung and colleagues addresses this issue. Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. We report an unusual case of severe hyponatremia of 100 mmoll normal range nr. Risk factors for thiazideinduced hyponatraemia qjm. Diureticinduced hyponatremia jama internal medicine.
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. Hyponatremia occurs when the concentration of sodium in your blood is abnormally low. 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. Diuretic induced hyponatremia in hypertensive patients. We report a case of duloxetine induced hyponatremia in. Thiazide diuretics interfere with maximum dilution of urine by blocking sodium chloride cotransport in the distal tubule, the main diluting site in the kidney. Phenotypic and pharmacogenetic evaluation of patients with thiazideinduced hyponatremia. Hyponatremia is a known adverse effect of duloxetine, and it can lead to potentially lifethreatening complications. 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.
457 1171 1499 417 233 1536 1572 870 382 266 841 333 979 1013 734 482 268 211 1487 1328 821 756 873 972 372 34 782 960 1411 191