The risk factors for the development of thiazideassociated hyponatremia are shown in table 1. Associated conditions eg, intractable diarrhea, tube feeding, hypoglycemic drugs, polydipsia, and cerebrovascular accidents may play a role in the pathogenesis of the syndrome. Patients with thiazideinduced hyponatremia are usually or antidepressant drugs such as fluoxetine may also produce siadh in a few patients. While cases of thiazideinduced hyponatremia are well documented, this severity 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. Ghose reported measurements of plasma avp in 6 patients with diureticinduced hyponatremia. Mechanisms include interference with maximal urinary dilution and stimulation of vasopressin release from mild volume depletion. Antimicrobials induced hyponatremia in elderly patients. In a series of patients with thiazideinduced hyponatremia reported by sonnenblick et al, 4 patients had their plasma vasopressin level measured, and in 3 of them, it was either low or below the level of detection. In practise, hyponatremia in patients on thiazides either alone or with reninangiotensinaldosterone.
The thiazide may be directly responsible, termed thiazide induced hyponatremia by the hyponatremia registry, which encompasses more than 5,000 patients with serum sodium levels. Diureticinduced hyponatraemia in elderly hypertensive. Severe diureticinduced hyponatremia in the elderly. 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. Thiazideassociated hyponatremia attenuates the fracture. Thiazides may be the sole cause and they may exacerbate. A genetic susceptibility has recently been uncovered. The risk of thiazide induced hyponatremia increases with age, is more common in females, and tends to. Pdf the importance of thiazideinduced hyponatremia tih is reemerging because thiazide diuretic prescription seems to be. With increasing polypharmacy and an ageing population, the prevalence of druginduced hyponatraemia is likely to increase. Hyponatremia is an uncommon, but serious, complication of diuretic therapy. 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.
Wed like to understand how you use our websites in order to improve them. Severe hyponatremia as a result of thiazide diuretic. Thiazide diuretics work at the site of the distal tubule by inhibiting uptake of sodium and chloride. Prospective controlled study comparing patients with previous thiazideinduced hyponatremia with two control groups. Leung md a adam wright phd a valeria pazo md a andrew karson md b david. Among the 26 with reversible thiazideinduced hyponatraemia, there were 10 with plasma sodium levels in the range 101109 mmoll. Results forty patients male and 27 female had diureticinduced hyponatremia, rendering it the most common cause of the disorder 25. Eleven patients with thiazideinduced kaluril hydrochlorothiazide, 50 mg. In all cases of druginduced hyponatremia, the potential exists for rapid correction of hyponatremia, especially when the offending agent is withdrawn because there is a risk for water diuresis when urinary concentration decreases and. You have free access to this content the journal of clinical hypertension volume 10, issue 6, article first published online. Diagnosis and treatment of hyponatremia inside the silver fridge.
Thiazide diuretics are among the most widely used treatments for hypertension, but thiazideinduced hyponatremia tih, a clinically significant adverse effect, is poorly understood. Patients with serum uric acid levels hyponatremia can complicate thiazide use in a minority of susceptible individuals and can result in significant morbidity and even mortality. Hyponatremia is an occasional but potentially fatal complication of diuretic therapy. The management of hyponatremia norbert lameire, 2015. Clinical and molecular features of thiazideinduced hyponatremia. Among the various causes of druginduced hyponatremia, thiazideinduced hyponatremia comprises a main cause, while loop diuretics only occasionally induce. It is also surprising that the free water clearance was not more significantly reduced in the patients, an expected accompaniment when serum sodium is. However, these medications can have unfavorable metabolic side effects including hyponatremia, hypokalemia, hypomagnesemia, hyperglycemia, hyperlipidemia, hyperuricemia. Risk factors for thiazideassociated hyponatremia include age, female sex, and possibly low body mass. 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. Druginduced hyponatraemia is commonly associated with diuretics, selective serotonin reuptake inhibitors and antiepileptics. We read with interest the report of friedman and colleagues 1 on thiazideinduced hyponatremia.
Virtually all cases of severe diureticinduced hyponatremia have been due to a thiazidetype diuretic. Treatment of severe hyponatremia kidney international. The onset of thiazideinduced hyponatremia may in some cases occur. This disorder may be present on admission to the intensive care setting or develop during hospitalization as a result of treatment or multiple comorbidities. Of these, 118 met criteria for true thiazideinduced hyponatremia tih. However, some patients given thiazides develop thiazide induced hyponatremia tih 5. W risk of thiazideinduced hyponatremia in patients with hypertension. To examine whether a subgroup of patients is particularly susceptible to this complication. Thiazide induced hyponatremia, a detailed phenotypic and. Thiazideinduced hyponatremia associated with death or neurologic damage in outpatients.
Volume 124, issue 11, november 2011, pages 10641072. Thiazide diuretics, select antidepressants, and anticonvulsants are frequently associated with hyponatremia. Electrolyte disturbance is common after administration of thiazide diuretics, and hyponatremia is a typical complication with an estimated incidence of 11% in one series of 114 geriatric patients19. Thiazideassociated hyponatremia, report of the hyponatremia. It is currently unclear whether thiazideassociated hyponatremia tah outweighs the protective effects of thiazide. Here, we have studied the phenotypic and genetic characteristics of patients hospitalized with tih. When a euvolemic patient receiving a thiazide manifests hyponatremia, it should be termed thiazide associated hyponatremia tah. Diureticinduced hyponatremia jama internal medicine. 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. Risk factors for thiazideinduced hyponatraemia qjm. Most patients with druginduced hyponatraemia are asymptomatic and the.
Risk of thiazideinduced hyponatremia in patients with hypertension. Clinical and molecular features of thiazideinduced. Thiazideinduced hyponatraemia is common and potentially life threatening. Uric acid homeostasis in the evaluation of diuretic. The risk of thiazideinduced hyponatremia increases with age, is more common in females, and tends to. Thiazide and thiazidelike diuretics are recommended as first line therapy for essential hypertension due to their significant morbidity and mortality benefit found in major rcts including allhat and shep.
To determine whether a singledose of thiazide administered to patients with previous thiazideinduced hyponatremia will cause hyponatremia and, if so, to analyze its pathogenesis. Thiazideinduced hyponatremia is predictable the american. Hyponatremia and thiazides hyponatremia and thiazides cohen, debbie l townsend, raymond r. 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. Of the 26, 11 had plasma potassium levels less than 3. Although they ascribe the pathogenesis of thiazideinduced hyponatremia to excess drinking, they did not monitor water intake. Hyponatremia is a wellrecognized complication of treatment with thiazide diuretics. In the absence of welldefined risk factors for this complication, guidelines for prescribing cannot be established. A minority of patients develop thiazideinduced hyponatremia tih and this is. However, some patients given thiazides develop thiazideinduced hyponatremia tih. Prospective controlled study comparing patients with previous thiazide induced hyponatremia with two control groups.
However, hyponatremia, an adverse effect of thiazide, is associated with increased risk of osteoporosis and fractures. Severe diureticinduced hyponatremia seems to be predisposed by age, sex, and body weight. Thiazide induced hyponatremia is this weeks version of. Patients with this entity are usually old, female, and underweight. The silent epidemic of thiazideinduced hyponatremia. Although frequently developing early after thiazide treatment initiation, many cases of. Although one might expect thiazide induced hyponatremia to be due to hypovolemia secondary to saliuresis, this is not the case. The presence of neurologic signs is an indication for active sodium replacement. Background thiazide, a firstline therapy for hypertension, lowers blood pressure, increases bone mineral density, and reduces the risk of fractures. As examples, carbamazepine and fluoxetine can produce hyponatremia with an siadhlike.
Sodium plus potassium concentration in urine exceeds that in the plasma, which directly lowers plasma sodium concentration. In the systolic hypertension in the elderly program shep, which focused on older patients, hyponatremia was observed in 4. Thiazideinduced hyponatremia and vasopressin release. Hyponatremia is the most frequently occurring electrolyte abnormality and can lead to lifethreatening complications. Pdf thiazideassociated hyponatremia in the elderly. 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.
Hyponatremia can complicate thiazide use in a minority of susceptible individuals and can result in significant morbidity and even mortality. Soon after their introduction in 1957, thiazide diuretics became a recognized cause of hyponatremia. Rodenburg et al have performed a populationbased cohort study looking at the risk of hyponatremia in thiazidetreated patients living in a suburb of rotterdam. Pdf thiazideinduced hyponatremia is one of the main causes of decreased sodium levels in elderly individuals. Low serum sodium concentration is not an uncommon frequent electrolyte disorder in the elderly population because of multiple risk factors contributing to increased antidiuretic hormone, the frequent prescription of drugs associated with hyponatremia, and also because of other mechanisms, such as the tea and toast. Only 42% of thiazide users had laboratory monitoring within 90 days after initiation. Thiazide diureticcaused hyponatremia in the elderly hypertensive.
Phenotypic and pharmacogenetic evaluation of patients with. With respect to the mechanisms of this hyponatremia, metolazone, a thiazide, was shown to turn a positive freewater clearance into a negative one 78 x 78 ashraf, n. 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. Rapid average correction of hyponatremia and a relatively high total correction over 20 meql in the first 24 h were significantly associated with higher mortality or demyelinating syndrome.
1630 355 935 888 10 289 459 299 768 1274 928 394 1034 377 1057 996 1422 1353 687 1064 1262 1536 498 71 1047 97 998 178 1006 527