Health Care Quality Special Reports

Recognizing and Treating Drug-Induced Hyponatremia July 2010 Patient Care Eileen McCaffrey A variety of drugs can lead to hyponatremia, typically defined as a serum sodium level below 135 mmol/L (N Engl J Med. 2007;356:2064–2072.). Clinicians often are cognizant of the risk with thiazide diuretics and carbamazepine but may not suspect other medications as causes of hyponatremia, said Denise H. Rhoney, PharmD, FCCM, FCCP, associate professor at the Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University in Detroit. Medications frequently are overlooked as a possible cause of hyponatremia, she said. The ideal treatment for medication-induced hyponatremia is to stop administering the offending drug and substitute an agent not associated with this complication, said Alpesh N. Amin, MD, MBA, professor of medicine and executive director of the hospitalist program at the School of Medicine of the University of California at Irvine. Doing so may not always be possible, however. Amin advises conducting a risk-benefit analysis to determine whether discontinuing the medication is the best course of action. Often, the clinician can substitute another agent that is not associated with hyponatremia. Some patients have multiple risk factors for hyponatremia. When a risk-benefit analysis suggests that the medication in question can be stopped safely, then withdrawing the drug is generally the first step in therapy, Amin said. In many cases, a clinician learns only in retrospect that a given agent was the cause of hyponatremia after the condition resolves with cessation of the medication (Am J Kidney Dis. 2008;52: 144–153). Common medication-related causes of hyponatremia include thiazide diuretics and antidepressants. Thiazide diuretics. These agents can lead to hyponatremia by impairing urinary diluting capacity (Crit Care Med. 2010;38[Suppl.]:S253–S264). Other mechanisms also have been proposed, including volume depletion that appropriately stimulates the secretion of arginine vasopressin ( .... You must sign-in to read complete article. If you are not registered click here. Username: Forgot it? Password: Financial support for this Website is provided by Premier Healthcare Resource.

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