Hyponatremia is a crucial complication of therapy with thiazide diuretics. This study compares the epidemiological and biochemical profiles and hospital course of patients using hydrochlorothiazide (HCTZ), indapamide (INDA), and chlorthalidone (CTD) admitted with thiazide-associated hyponatremia (TAH). Data were obtained retrospectively from the hospital's digital registries. The epidemiological and biochemical parameters between the HCTZ, INDA, and CTD groups were compared. The correlation between dose and biochemical parameters in each group was performed. The thiazide groups without diuretic co-medication were compared (HCTZ vs. INDA), and the correlation between dose and biochemical parameters in each group was examined. A comparison of the HCTZ (n = 135), INDA (n = 125), and CTD (n = 27) groups identified differences in serum potassium (s-K; p = 0.03). The hyponatremia correction rate was slower in the CTD group at 96 h after admission (p < 0.001). After the exclusion of diuretic co-medication, the HCTZ group (n = 64/135) showed a higher prevalence of ARBs, s-K (both p < 0.001), and a lower median (IQR) equipotent dose (12.5 (o) mg vs. 2.5 (1.2) mg), prevalence of ACE-I (p < 0.001), and eGFR (p = 0.03), when compared to the INDA group (n = 109/125). In conclusion, except for s-K, we observed no significant difference in biochemical and epidemiological profiles between HCTZ, INDA, and CTD. After excluding the influence of other diuretics, we observed higher s-K in the HCTZ group compared to the INDA group, potentially explained by the lower equipotent dose of HCTZ. The CTD group showed a statistically significant trend of slower hyponatremia correction.
- Klíčová slova
- chlorthalidone, hydrochlorothiazide, hyponatremia, indapamide, thiazide diuretics, thiazide‐associated hyponatremia,
- MeSH
- antihypertenziva škodlivé účinky MeSH
- chlorthalidon * škodlivé účinky terapeutické užití aplikace a dávkování MeSH
- diuretika škodlivé účinky MeSH
- draslík krev MeSH
- hydrochlorthiazid * škodlivé účinky terapeutické užití aplikace a dávkování MeSH
- hypertenze * farmakoterapie MeSH
- hyponatremie * chemicky indukované epidemiologie krev MeSH
- indapamid * škodlivé účinky terapeutické užití aplikace a dávkování MeSH
- inhibitory symportérů pro chlorid sodný škodlivé účinky MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Názvy látek
- antihypertenziva MeSH
- chlorthalidon * MeSH
- diuretika MeSH
- draslík MeSH
- hydrochlorthiazid * MeSH
- indapamid * MeSH
- inhibitory symportérů pro chlorid sodný MeSH
Hyponatremia is a typical side effect of antiseizure drugs from the dibenzazepine family. The study investigated the prevalence of hyponatremia in patients with epilepsy who were treated with eslicarbazepine. We aimed to determine the prevalence of hyponatremia, reveal the factors leading to the discontinuation of treatment, and identify possible risk factors for the development of hyponatremia including the dose dependency. The medical records of 164 patients with epilepsy taking eslicarbazepine in our center were analyzed. The overall prevalence of hyponatremia was 30.5%. The prevalence of mild hyponatremia, seen in 14%-20% of patients, was not dose dependent. The prevalence of moderate and severe hyponatremia was significantly dose dependent. The severity of hyponatremia was significantly dose dependent. Severe hyponatremia was found in 6.1% of patients. Hyponatremia was asymptomatic in the majority of cases, and in 48% did not require any management. Hyponatremia was the reason for discontinuation in 6.2% of patients. The major risk factor for developing hyponatremia was older age. The study shows that eslicarbazepine-induced hyponatremia is usually mild and asymptomatic. It usually does not require any management and seldom leads to treatment discontinuation. Hyponatremia is dose dependent. Another major risk for developing hyponatremia (besides dose) is older age.
- Klíčová slova
- eslicarbazepine, hyponatremia, risk factor,
- MeSH
- antikonvulziva škodlivé účinky MeSH
- dibenzazepiny * škodlivé účinky MeSH
- epilepsie * farmakoterapie komplikace MeSH
- hyponatremie * chemicky indukované epidemiologie MeSH
- lidé MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antikonvulziva MeSH
- dibenzazepiny * MeSH
- eslicarbazepine MeSH Prohlížeč
- Klíčová slova
- Diuretic-induced hyponatremia, Fractional excretion, Furosemide, Hyponatremia, Hypovolemic hyponatremia,
- MeSH
- diuretika škodlivé účinky MeSH
- furosemid * škodlivé účinky MeSH
- hyponatremie * chemicky indukované epidemiologie MeSH
- lidé MeSH
- sodík MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
- Názvy látek
- diuretika MeSH
- furosemid * MeSH
- sodík MeSH
OBJECTIVES: Thiazide-associated hyponatremia (TAH) is a clinically important side effect of the therapy with thiazide and thiazide-like diuretics. This study aims to analyze epidemiological, biochemical, and symptomatological profiles (including volume status) of patients admitted with TAH. METHODS: A retrospective hospital record study was performed. Epidemiological and biochemical parameters and symptoms were compared between the thiazide (n = 143) and non-thiazide (n = 282) groups. Patients in the thiazide group were classified as hypo-, normo-, or hypervolemic. Furthermore, the comparison of epidemiological, biochemical, partially pharmacotherapeutical, and symptomatological parameters between the hypovolemic and normovolemic TAH groups was performed. RESULTS: The thiazide group showed lower s-Na (p = 0.008), s-K (p < 0.001), s-Cl (p < 0.001), measured s-osmolality (p = 0.021), and eGFR (p < 0.001); higher s-urea (p < 0.001), s-creatinine (p = 0.023), s-glucose (p < 0.001), u-osmolality (p = 0.012), u-Na (p < 0.001), u-K (p = 0.023), and u-Cl (p < 0.001). Patients using thiazide were older (p < 0.001), more likely to be female (p = 0.011), and with symptoms corresponding more to chronic hyponatremia. Compared to the normovolemic group (n = 93; 65%), the hypovolemic patients (n = 47; 32.9%) showed higher s-urea (p = 0.005), s-creatinine (p = 0.045), and s-UA (p = 0.010); lower eGFR (p = 0.032), u-Na (p = 0.015), u-Cl (p = 0.016), anorexia (p < 0.001), and a higher frequency of furosemide use (p < 0.001). CONCLUSIONS: Thiazide use is a crucial etiological cause of hypotonic hyponatremia among internal medicine inpatients, associated with more severe hyponatremia, but with no difference in the in-hospital mortality. Even in hypo-osmolar conditions of TAH, 32.9% of patients exhibited signs of volume depletion. FE-UA did not differ between the hypovolemic and the normovolemic patients in TAH conditions. Anorexia and the combination of thiazide together with furosemide, rather than thiazide use alone, were risk factors for hypovolemic hyponatremia without affecting FE-UA.
- Klíčová slova
- Thiazide, hyponatremia, thiazide-associtated hyponatremia (TAH), thiazide-induced hyponatremia (TIH), uric acid,
- MeSH
- furosemid MeSH
- hyponatremie * chemicky indukované epidemiologie MeSH
- hypovolemie chemicky indukované MeSH
- kreatinin MeSH
- lidé MeSH
- močovina MeSH
- nechutenství chemicky indukované komplikace farmakoterapie MeSH
- retrospektivní studie MeSH
- sodík MeSH
- thiazidy * škodlivé účinky MeSH
- vnitřní lékařství MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- furosemid MeSH
- kreatinin MeSH
- močovina MeSH
- sodík MeSH
- thiazidy * MeSH
Terlipressin is a vasopressin analogue used for its vasoconstrictor effect in the treatment of variceal bleeding. Despite its good safety profile compared to vasopressin, some adverse reactions may occur during its use - e.g. hyponatremia. We describe a case of a cirrhotic patient with active variceal bleeding treated during two separate hospitalizations with terlipressin. In both drug treatment periods, severe laboratory hyponatremia developed. After terlipressin discontinuation, mineral disbalance corrected rapidly. Positive dechallenge and rechallenge corresponding to the drug administration schedule confirms the causality between terlipressin administration and hyponatremia. Hyponatremia was preceded with substantial fluid retention in both episodes. In this case report we want to highlight the need for fluid balance monitoring immediately after first terlipressin dose, which may individually predict the patient risk for the development of hyponatremia as other risk factors have rather limited predictive value in real clinical settings.
- Klíčová slova
- Adverse drug reaction, Fluid balance, Hyponatremia, Terlipressin, Vasopressin receptor,
- MeSH
- dospělí MeSH
- ezofageální a žaludeční varixy komplikace MeSH
- hematemeze farmakoterapie etiologie patofyziologie MeSH
- hyponatremie * chemicky indukované diagnóza terapie MeSH
- jaterní cirhóza komplikace MeSH
- lidé MeSH
- lypresin aplikace a dávkování škodlivé účinky analogy a deriváty MeSH
- terlipresin MeSH
- vazokonstriktory aplikace a dávkování škodlivé účinky MeSH
- vodní a elektrolytová nerovnováha diagnóza etiologie prevence a kontrola MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
- Názvy látek
- lypresin MeSH
- terlipresin MeSH
- vazokonstriktory MeSH
The authors present a case-report of a 73 years old woman treated for arterial hypertension within past 15 years with diuretics (thiazides, amiloride and indapamide) and concomitantly with antidepressive trazodone. The patient developed severe osteoporosis after 6 years of such a treatment with multiple fractures even after minor trauma; during whole this period severe hyponatremia without adequate supplementation was documented. Most probably, there exists tight relationship of osteoporosis and hyponatremia in this patient - the authors discuss possible pathophysiological mechanisms at the level of renal tubules, osteoblasts and osteoclasts, hypopituitary-skeletal axis, syndrome of inadequate adiuretin secretion (SIADH) and possible influence of acid-base balance disturbances.
- MeSH
- antidepresiva aplikace a dávkování škodlivé účinky MeSH
- diuretika aplikace a dávkování škodlivé účinky MeSH
- hypertenze farmakoterapie MeSH
- hyponatremie chemicky indukované MeSH
- lidé MeSH
- osteoporóza farmakoterapie MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- antidepresiva MeSH
- diuretika MeSH
The authors present an overview of the most often discussed questions concerning citalopram, i.e. its proven effect on the QT interval and related dose reductions. They discuss citalopram's antiplatelet effect including the most recent data and draw attention to serotonin syndrome as its incidence is still underestimated. They go on to discuss hyponatremia pointing out that this condition may develop even in those taking low doses of citalopram. Finally, the authors provide a brief overview of the latest findings on osteoporosis and the serotonergic mechanism inducing it in individuals treated with a selective serotonin reuptake inhibitor.
- MeSH
- antagonisté serotoninu aplikace a dávkování škodlivé účinky farmakologie MeSH
- citalopram aplikace a dávkování škodlivé účinky farmakologie MeSH
- hyponatremie chemicky indukované MeSH
- inhibitory agregace trombocytů aplikace a dávkování škodlivé účinky farmakologie MeSH
- lidé MeSH
- osteoporóza chemicky indukované MeSH
- Romanův-Wardův syndrom chemicky indukované MeSH
- serotoninový syndrom chemicky indukované MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- antagonisté serotoninu MeSH
- citalopram MeSH
- inhibitory agregace trombocytů MeSH
Hyponatremia can be defined like the low sodium concentration, lower that 135 mmol/l. It becomes really serious when the concentration is lower than 120 mmol/l. The most frequent causes of hyponatremia are: the extrarenal loss (GIT, skin, bleeding, sequestration), the renal loss (diuretics, nephritis with the salt loss, osmotical diuresis, the Addison disease), hypothyroidism, the lack of glucocorticoids, emotional stress, pain, pseudohyponatremia (incorrect taking, dyslipoproteinemia). There is fatigue, exhaustion, headache and vertigoes dominating in the clinical record file. By the deficit increasing a patient becomes delirious, comatose even with the shock development. It is necessary to separate sufficient supply of sodium from much more often reason, which is loss of sodium which can be caused by: excessive sweating, vomitting with the metabolical alkalosis development, diarrhoea with the metabolical acidosis development, renal losses (a phase of renal failure). Treatment of hyponatremia: intensive treatment starts at the level of plasmatic concentration of sodium under 120 mmol/l or when neurological symptoms of brain oedema are present. In the therapy it is necessary to avoid fast infusions of hypertonic saline solutions (3-5% NaCl solutions) because of the danger of the development of serious CNS complications (intracranial bleeding, etc.). It is recommended to adjust the plasmatic concentration of sodium up to 120 mmol/l during the first four hours and a subsequent correction should not be higher than 2 mmol per an hour. Treatment of the basic illness is very important. We present 2 case histories: a 74-year old female patient and a 69-year old female patient both with the hyponatremia caused by taking of carbamazepine. We want to inform and warn about not only a well known side effect during long-term treatment but about hyponatremia that arose within 48 hours after the start of taking medicine as well.
- MeSH
- antikonvulziva škodlivé účinky MeSH
- hyponatremie chemicky indukované diagnóza terapie MeSH
- karbamazepin škodlivé účinky MeSH
- lidé MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- antikonvulziva MeSH
- karbamazepin MeSH
Seven cases of cerebral oedema have been observed in enuretic children during low-dose desmopressin (DDAVP) treatment given in a dose of 7-21 microg daily in the Czech Republic between 1995 and 1999, after the drug started to be marketed for this indication and delivered in simple bottles with a dropper. All seven children (age 5-11 years, four boys) experienced a period of unconsciousness but all recovered without sequelae. In most cases, safety measures were underestimated and natraemia was not regularly controlled. Two children developed cerebral oedema after excessive water intake in preparation for uroflowmetry, another one drank much during a hot summer day, in one diabetes insipidus was not recognised and two children were clearly non-compliant with reduced fluid intake on a long-term basis. Only in one child, no risk factor was found. Conclusion. Proper selection and instruction of patients is needed to avert cerebral oedema during treatment with desmopressin for nocturnal enuresis.
- MeSH
- desmopresin škodlivé účinky MeSH
- dítě MeSH
- edém mozku chemicky indukované prevence a kontrola MeSH
- enuréza farmakoterapie MeSH
- hyponatremie chemicky indukované prevence a kontrola MeSH
- intoxikace vodou chemicky indukované prevence a kontrola MeSH
- ledvinné látky škodlivé účinky MeSH
- lidé MeSH
- předškolní dítě MeSH
- spotřebitelská bezpečnost produktů MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- desmopresin MeSH
- ledvinné látky MeSH
