A probable case of syndrome of inappropriate antidiuretic hormone secretion associated with linezolid

Baik, Seung Hee; Choi, Yoon Kyung; Kim, Hyun Seo; Yoon, Young Kyung

doi:10.2146/ajhp150208

Cited by 10 publications

(13 citation statements)

References 13 publications

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“…15) In their study, SIADH-induced hyponatremia occurred following linezolid treatment for more than 3 weeks, and the hyponatremia resolved after the cessation of linezolid. However, recent in vitro 24,25) and in vivo 26) studies demonstrated that linezolid had anti-inflammatory effects, in addition to its antimicrobial effects.…”

Section: Discussionmentioning

confidence: 95%

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A Retrospective Analysis of Risk Factors for Linezolid-Associated Hyponatremia in Japanese Patients

Tanaka

Suzuki

Takumi

et al. 2016

Biological & Pharmaceutical Bulletin

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Linezolid is an oxazolidinone antibiotic against Gram-positive bacteria. Although thrombocytopenia is a major adverse effect of linezolid, hyponatremia also often develops after linezolid administration. This study examined the frequency of hyponatremia that developed during linezolid treatment and identified its risk factors. In this retrospective, single-center, observational cohort study, 61 hospitalized patients treated with linezolid between January 2013 and January 2015 were analyzed. Hyponatremia was defined as a sodium level of ≤134 mEq/L for the duration of linezolid treatment. Its risk factors were identified via a logistic regression analysis. Hyponatremia occurred in 11 (18.0%) patients, and it was severe in a case (a sodium level of ≤128 mEq/L). Univariate and multiple logistic regression analyses identified the plasma C-reactive protein (CRP) level before the initial administration of linezolid and the concomitant use of a potassium-sparing diuretic as the independent variables associated with the development of hyponatremia. The odds ratios were 1.081 (95% confidence interval [CI]; 1.008-1.158) (p 0.028) and 11.017 (95% CI; 1.869-64.939) (p 0.008), respectively. Before linezolid treatment, the CRP levels of the hyponatremia group were significantly higher than those of the no-hyponatremia group (p<0.001). The frequency of hyponatremia development was significantly higher in the patients who received both the potassium-sparing diuretic and linezolid ( p 0.016). These results suggest that the plasma sodium levels of patients with severe inflammation who are treated with linezolid and those of linezolid-treated patients co-administered a potassium-sparing diuretic should be continuously monitored.

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Section: Discussionmentioning

confidence: 95%

“…13) A few cases of severe hyponatremia after linezolid administration have been reported. 14,15) However, there have been no studies of the frequency of linezolid-induced hyponatremia and its risk factors.…”

mentioning

confidence: 99%

A Retrospective Analysis of Risk Factors for Linezolid-Associated Hyponatremia in Japanese Patients

Tanaka

Suzuki

Takumi

et al. 2016

Biological & Pharmaceutical Bulletin

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“…Linezolid is an antibiotic that has been described to cause mild hyponatremia in up to 18% in a small cohort of patients; however, the mechanism is not clear, and severe hyponatremia (≤128 mEq/L) is extremely rare (1.6% of patients) and is generally not considered to be associated with SIADH . Baik et al reported the case of a patient who developed hyponatremia during treatment with linezolid with findings suggestive of SIADH implying that either linezolid directly stimulated the production of ADH or that ADH was produced due to a drug to drug interaction of linezolid with buspirone that the patient was also receiving …”

Section: Details Of the Casementioning

confidence: 65%

“…Its use, however, is limited by its cost and the adverse effects that are associated with prolonged use, such as myelosuppression. Linezolid can cause other adverse effects, like diarrhoea, nausea, lactic acidosis and serotoninergic syndrome, whereas case reports have suggested that it can cause hyponatremia …”

Section: What Is Known and Objectivementioning

confidence: 99%

A case of severe hyponatremia due to linezolid-induced SIADH

et al. 2018

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“…The patient was euvolaemic and serum and urine osmolality were 254 and 433 mOsmol/Kg, respectively. A diagnosis of drug‐induced syndrome of inappropriate antidiuretic hormone (SIADH) was made, and the sodium levels slowly came back to normal after withdrawal of the drug . Despite continuous infusion of dextrose and normal saline, he had a further episode of severe hypoglycaemia (36 mg/dL) within 48 hours of admission and lead to further aspiration and drop in hemodynamics.…”

Section: Case Descriptionmentioning

confidence: 99%

Linezolid‐induced rare triad of hypoglycaemia, bone marrow suppression and hyponatraemia in elderly

2019

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What is known and objective Linezolid, a member of the oxazolidinone class of antibacterial drugs, is approved by the US Food and Drug Administration (FDA) for the treatment of vancomycin‐resistant Enterococcus faecium infections, nosocomial and community‐acquired pneumonia, as a part of anti tubercular regimen and complicated and uncomplicated skin and soft tissue infections, including diabetic foot infections. Linezolid has potential adverse effects like bone marrow suppression, peripheral neuropathy and hyponatremia. One of the extremely rare reported adverse effects of the drug is hypoglycaemia. We present a case of Linezolid toxicity presenting as resistant hypoglycemia, bone marrow suppression and severe hyponatremia all together in a single patient. Case description We present a case of an 82 years old gentleman with no known chronic co‐morbidities. He was started on Linezolid 600 mg twice a day for 10 days by a local doctor possibly for some minor infection post hip surgery. He was in respiratory distress on arrival. Blood sugars showed severe hypoglycemia of 36 mg/dL (2.0 mmol/L). He was admitted in intensive care unit and started on injectable antibiotics and 5% dextrose infusion and sugars were strictly monitored. His blood tests revealed severe hyponatremia with sodium level of 119 mEq/L and haemoglobin (Hb) of 8.8 gm/dL, leucocytes of 6500/µL, platelets of 82 000/µL. The infection markers were normal throughout. The platelet count went progressively down from 82 000/µL on admission to 20 000/µL 2 days later; before it started rising back. Similarly there was drop in Hemoglobin and white cell counts. He required vasopressors to maintain mean arterial pressures. The blood sugar levels stabilized after the same. However patient had suffered acute lung injury secondary to aspiration and became NIV dependent and eventually passed away. What is new and conclusion Our case was unique in a way that our patient had adverse effects of linezolid like myelosuppression as well as the rare side effects of hypoglycemia at the same time. This combination of adverse events has never been described in the past to our knowledge. All the adverse effects responded to antibiotic de‐challenge in our case. We had ruled out the possibility of other causes of Hypoglycemia such as sepsis, insulinoma, alcohol excess, malnutrition or hypoadrenalism. We searched the PubMed database and found four case reports out of which two were diabetics and other two were non diabetics. Out of 15 cases described by Vishwanathan et al only three cases were non diabetics. Our patient was non diabetic as well. Therefore our case is only the sixth reported case of hypoglycemia in non diabetic receiving Linezolid to our knowledge.

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A probable case of syndrome of inappropriate antidiuretic hormone secretion associated with linezolid

Abstract: SIADH was observed in a woman who was administered linezolid for more than three weeks, with concurrent development of progressive severe anemia associated with linezolid toxicity. The patient's hyponatremia resolved after cessation of linezolid use.

Cited by 10 publications

References 13 publications

A Retrospective Analysis of Risk Factors for Linezolid-Associated Hyponatremia in Japanese Patients

A Retrospective Analysis of Risk Factors for Linezolid-Associated Hyponatremia in Japanese Patients

A case of severe hyponatremia due to linezolid-induced SIADH

Linezolid‐induced rare triad of hypoglycaemia, bone marrow suppression and hyponatraemia in elderly

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