Pantoprazole Sodium–Induced Hyponatremia in a Frail Elderly Adult

Abstract

Crusted scabies is another important differential in any elderly adult with an itchy, psoriasiform scalp eruption. Individuals at higher risks include those who are bedbound with multiple medical comorbidities and poor mobility.The prognosis in MF is worse in men, older adults, at a higher stage of disease, and with the folliculotropic variant of MF. 2 This woman had at least T3N1M0B0 disease, compatible with Stage IIB, which is advanced. 4 Overall survival at this stage is 37.8% to 63.2% at 5 years after diagnosis and 19.8% to 53.2% at 10 years. 2 Systemic therapy is indicated because of extensive skin and lymph node involvement. Choices include retinoid (bexarotene), interferon, histone deacetylase inhibitors (e.g., romidepsin, vorinostat), chemotherapy (e.g., methotrexate, doxorubicin, gemcitabine, cyclophosphamide, chlorambucil, fludarabine, etoposide), and biologic agents (e.g., bortezomib, alemtuzumab). 5,6 Because these treatments are expensive and not readily available, this woman was fortunate to receive the biological treatment and chemotherapy free of charge and had a good outcome.

Pantoprazole-related Symptomatic Hyponatremia

“…More recently, there were also reports of hyponatremia related to esomeprazole and pantoprazole4,5. In the case of the latter, a frail elderly adult achieved normal serum sodium levels three months after stopping treatment with pantoprazole5. In our case, serum sodium levels reached normal values two months after the suspension of pantoprazole.…”

“…According to Naranjo Criteria5, there is a possible relation between hyponatremia and pantoprazole in this case report.…”

“…Furthermore, there is one case reporting symptoms reappearance when the patient was re-challenged with the drug3. More recently, there were also reports of hyponatremia related to esomeprazole and pantoprazole4,5. In the case of the latter, a frail elderly adult achieved normal serum sodium levels three months after stopping treatment with pantoprazole5.…”

“…The underlying pathophysiological mechanism of hyponatremia related to PPIs is not entirely clear and it is thought to be caused by SIADH. An excessive loss of urinary sodium seems more probable than water retention alone, but causality between PPI-induced hyponatremia and renal salt wasting has not been definitively proven3–5. This relation was found to be difficult to assess since this adverse drug reaction is generally encountered in elderly patients, who also have physiologic changes in water and electrolyte balance that occur as part of the normal aging process4.…”

Omeprazole-induced and pantoprazole-induced asymptomatic hyponatremia: a case report

“…However, with long-term use several adverse effects are reported, such as a changed gut microbiome, fundic mucosal hypertrophy, Clostridium difficile infection, vitamin B12 deficiency, hypomagnesemia, and acute interstitial nephritis [11]. There are only a few reports on PPI-induced hyponatremia with either omeprazole or pantoprazole [12][13][14][15]. Durst et al reported the reoccurrence of hyponatremia after reintroducing omeprazole [12].…”