Ibuprofen Can Induce Syndrome of Inappropriate Diuresis in Healthy Young Patients

Abstract

A 30-year-old caucasian woman, without past medical history or known drug use, was admitted to the emergency department for persistent fever and arthralgias. The laboratory analysis showed moderate hypoosmolar hyponatremia (Na: 132 mmol/L, osmolality: 239 mOsm/L), normal sodium excretion (<20 mmol/L), and a high urinary osmolality (415 mOsm/L). Later, she deteriorated with seizures and deeper hyponatremia (Na: 113 mmol/L) and so was moved to the critical care unit. At first, no obvious aetiology was found, the patient was euvolemic, as she was well hydrated and lacked concerning findings of heart failure, renal disease, or liver cirrhosis. A syndrome of inappropriate diuresis (SIAD) was proposed, and corrective measures were started immediately to reduce her hyponatremia, including restriction of fluid intake. The administration of intravenous hypertonic saline solution permitted normal neurological status to be restored and corrected the sodium concentration but induced reversible acute renal failure. Further investigation revealed that the patient had ingested 8 g ibuprofen two days before admission. After other aetiologies were ruled out, drug-induced SIAD due to ibuprofen was the most likely diagnosis for this patient. SIAD-associated hyponatremia and acute renal failure are rare side effects of nonsteroidal anti-inflammatory drugs, particularly in young people. Therefore, this case may represent a unique case of NSAID-induced SIAD and highlight the need to obtain thorough medication histories and exclude all other potential causes in hyponatremic patients.

NSAIDs in CKD: Are They Safe?

“…57 Finally, several reports suggest an association between NSAID use and syndrome of inappropriate ADH secretionmediated hyponatremia. 58,59 ADH levels can be persistently elevated in patients with CKD, particularly in those with underlying diabetes mellitus. 60 Individuals with CKD also have comorbid conditions such as CHF, nephrotic syndrome, and cirrhosis, which increase nonosmotic ADH production, predisposing to NSAID-induced hyponatremia.…”

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Induced by Long-Term Use of Citalopram and Short-Term Use of Naproxen

“…NSAIDs is also a class of medications that can cause SIADH [ 1 , 2 , 4 , 11 ]. A 2013 review article showed at least 11 patients reporting SIADH secondary to NSAIDs were using ibuprofen (4/11) or diclofenac (2/11) [ 1 ].…”

Review article: Investigations and the pregnant woman in the emergency department – part 1: Laboratory investigations

“…Hyponatraemia with a picture of SIADH may also be seen with prolonged labour, post-Caesarean section, and with the use of nonsteroidal anti-inflammatory drugs for analgesia postpartum. [39][40][41] Severe hyponatraemia has also been reported with oxytocin infusions for induction of labour, primary polydipsia and hyperemesis gravidarum. [42][43][44][45] Glucocorticoid deficiency and/or hypothyroidism related to Sheehan's syndrome and lymphocytic hypophysitis should be excluded in women with peripartum hyponatraemia.…”

“…Possible explanations include insufficient vasopressinase produced by a defective placenta, or excess ADH or oxytocin produced by placenta or myometrium due to premature contractions under the influence of ovarian steroids. Hyponatraemia with a picture of SIADH may also be seen with prolonged labour, post‐Caesarean section, and with the use of non‐steroidal anti‐inflammatory drugs for analgesia postpartum . Severe hyponatraemia has also been reported with oxytocin infusions for induction of labour, primary polydipsia and hyperemesis gravidarum …”