Diuretic-Induced Hyponatremia

Diuretic induced hyponatraemia in elderly hypertensive women

“…Numerous case reports have indicated that hypertensive women are particularly at risk to develop hyponatraemia. 11,[15][16][17][18][19][20][21][22] However, since hypertensive women are more often treated with diuretics than hypertensive men, 23,24 they may be more susceptible to develop hyponatraemia. Moreover, women are more symptomatic than men at similar serum sodium levels and therefore may be diagnosed more often than men.…”

Hyponatraemia

“…Hyponatraemia most commonly occurs within 14 days of starting therapy (Sonnenblick et al, 1993), but may occur after prolonged periods of trouble-free treatment. Diuretic-induced hyponatraemia is multifactorial: excess natriuresis without adequate oral sodium replacement, and baroregulated vasopressin release in response to diuretic induced hypovolaemia are probably the most important mechanisms, but hypokalaemia, which promotes movement of sodium into cells, may also contribute to lowering extracellular sodium levels (Fichmann q 2000 Blackwell Science Ltd, Clinical Endocrinology, 52, 667±678 , 1971;Hamburger et al, 1981). Although the overwhelming majority of cases of thiazide-induced hyponatraemia are associated with natriuresis and hypovolaemia, thiazide diuretics have also been reported to potentiate the effect of small concentrations of vasopressin, permitting maximal reabsorption of water (Pitone et al, 1978;Sonnenblick et al, 1993), with occasional development of the syndrome of inappropriate antidiuretic hormone (SIADH), rather than hypovolaemic hyponatraemia (VanAssen & Mudde, 1999).…”

Electrolyte Imbalance Caused by Diuretic Therapy in Infants with Congenital Heart Diseases

“…In children, various side effects such as cholelithiasis in premature infants receiving total parenteral nutrition concomitantly, secondary hyperparathyroidism and bone disease, drug-induced fever and sensorineural hearing loss in infants with respiratory distress were reported [5][6][7]. The chronic adverse effects of diuretics on serum electrolytes are well known and numerous reports documented the occurrence of diuretic-induced hyponatremia in adult patients [8][9][10][11]. The elderly seem to be at increased risk and several series found that 80% of patients are women [9][10][11][12].…”

“…Although the decrease in serum sodium after starting diuretic therapy is usually modest, severe hyponatremia (serum sodium level <115 mEq/L) can develop in a susceptible subgroup of outpatients [8,9,11]. Thiazides have been implicated most often and combinations of thiazides with amiloride or triamterene may also be responsible [12].…”