Risk factors for thiazide-induced hyponatraemia

Chow, Kai Ming; Szeto, Cheuk‐Chun; Wong, Tze-Wai; Leung, Chi Bon; Li, P.K.-T.

doi:10.1093/qjmed/hcg157

Cited by 143 publications

(117 citation statements)

References 43 publications

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“…16 Serum uric acid levels, which typically rise with volume depletion, were lower in patients with thiazide-induced hyponatremia as compared with normonatremic patients taking thiazides. 15 Taken together, these data suggest a role for abnormal thirst and water intake in individuals who develop thiazide-induced hyponatremia.…”

Section: S4mentioning

confidence: 81%

“…14 Although most patients with diuretic-induced hyponatremia are women, whether female sex or lower body weight confers increased risk is uncertain. 15 Patients with a prior episode of thiazide-induced hyponatremia demonstrate increased susceptibility to a recurrence. When compared with both elderly and young controls, patients with a prior history had lower basal urine osmolality and demonstrated a greater decrease in serum [Na ϩ ] after rechallenge with a single dose of diuretics.…”

Section: S4mentioning

confidence: 99%

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Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Verbalis

Goldsmith

Greenberg

et al. 2007

The American Journal of Medicine

511

490

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Although hyponatremia is a common, usually mild, and relatively asymptomatic disorder of electrolytes, acute severe hyponatremia can cause substantial morbidity and mortality, particularly in patients with concomitant disease. In addition, overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death, and optimal treatment strategies for such cases are not established. Hyponatremia is the most common disorder of electrolytes encountered in clinical practice, occurring in up to 15% to 30% of both acutely and chronically hospitalized patients. 1 Although most cases are mild and relatively asymptomatic, hyponatremia is important clinically because: (1) acute severe hyponatremia can cause substantial morbidity and mortality; (2) mortality is higher in patients with hyponatremia who have a wide range of underlying diseases; and (3) overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death.Despite knowledge of hyponatremia since the mid-20th century, this common disorder remains incompletely understood in many basic areas because of its association with a plethora of underlying disease states, and its multiple etiologies with differing pathophysiologic mechanisms. 2 Optimal treatment strategies have not been well defined, both for these reasons and because of marked differences in symptomatology and clinical outcomes based on the acuteness or chronicity of the hyponatremia. 3 Vasopressin receptor antagonists have long been anticipated as a more effective method to treat hyponatremia by virtue of their unique aquaretic effect to selectively increase solute-free water excretion by the kidneys. 4 The recent approval of the first such agent, conivaptan, for clinical use by the US Food and Drug Administration (FDA) heralds the beginning of a new era in the management of hyponatremic disorders. However, effective therapy with these agents will require intelligent guidelines for their use. To this end, a panel of experts in hyponatremia convened to review current therapies for hyponatremia and to evaluate the situations in which aquaretic agents should be considered as alternatives or supplements to accepted current therapies. This review is a summary of the conclusions of this panel.

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Section: S4mentioning

confidence: 81%

Section: S4mentioning

confidence: 99%

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Verbalis

Goldsmith

Greenberg

et al. 2007

The American Journal of Medicine

511

490

View full text Add to dashboard Cite

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“…23 However, this study did not adjust for the confounding effect of concomitant medications and other reported risk factors like weight, renal function etc. 24,25 …”

Section: Discussionmentioning

confidence: 99%

A comparative analysis of hydrochlorothiazide and chlorthalidone induced hyponatremia at the dose commonly prescribed in clinical practice

Mishra

Panda

2018

Int J Basic Clin Pharmacol

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INTRODUCTIONThiazide and thiazide like diuretics have been used in the management of hypertension for a longer period than any other anti-hypertensive agent.1 They are recommended as the first line agents by the JNC 7. They have also been included as a major class of anti-hypertensives in the JNC 8 recommendations. Thiazide diuretics are often considered a homogeneous therapeutic class, where all agents reduce cardiovascular event risk and all-cause mortality in elderly hypertensive patients equally, as a direct consequence of anti-hypertensive effects.2 However, not all thiazide-related medications have the same properties. Many studies have contrasted the most widely used thiazide diuretic, hydrochlorothiazide (HCTZ), and the thiazide-like diuretic, chlorthalidone (CTD), with ABSTRACT Background: Despite the differences in cardiovascular outcomes, pharmacokinetics, pharmacodynamics, the diuretics, chlorthalidone (CTD) and hydrochlorothiazide (HCTZ) are often considered as interchangeable. There is an on-going debate whether CTD should be preferred over HCTZ, because it appears to be more effective in the prevention of cardiovascular events. The relative difference in the incidence of hypokalemia and hyponatremia, is also a topic of debate. With this background, the study was carried out to compare the prevalence of hyponatremia between CTD and HCTZ used in the treatment of hypertension at the dose commonly prescribed in clinical practice. Methods: This was a cross sectional study carried out on a convenience sample of 74 adult patients with provisional diagnosis of hyponatremia or with a plasma sodium level of less than 135mmol/L and having a history of anti-hypertensive use of HTCZ or CTD in the dose range of 12.5-25mg/day and 6.25-12.5mg/day respectively. Chi square test and independent samples 't' test were used analyse the results in GraphPad Prism 6.0. Results: HCTZ was found to be the preferred diuretic in hypertension, whereas CTD was preferred in the age group of 65-74 years. The symptoms indicative of hyponatremia as well as a lower plasma sodium level were more common in the HTCZ treated group. Patients of hypertension using CTD were less predisposed to hyponatremia (OR 0.804,. Conclusions: Chlorthalidone, when used at a lower dose of 6.25-12.5mg/day for the treatment of hypertension cause a lesser risk of hyponatremia than hydrochlorothiazide.

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“…[7][8][9] The elderly appear to be more prone to TIH as they do not excrete free water as efficiently as younger subjects. 9 Blunted prostaglandin synthesis may contribute, along with polypharmacy, particularly including nonsteroidal anti-inflammatory agents.…”

Section: Epidemiologymentioning

confidence: 99%

A review of thiazide-induced hyponatraemia

2011

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-There are numerous reports of thiazide-induced hyponatraemia (TIH) and its incidence is growing as a result of increasing prescription after guidelines recommending thiazides as first-line treatment of essential hypertension have been introduced. Thiazide diuretics are a common cause of severe hyponatraemia that is usually induced within two weeks of starting the thiazide diuretic, but it can occur any time and very rapidly in susceptible patients. Despite several relevant reports and years of clinical experience, TIH remains a very common clinical scenario. Although its impact has recently been reviewed, little attention has been given to the practical approach for preventing this medical complication. In the present review, the epidemiology, pathogenesis, clinical presentation and management of TIH are discussed, and an approach to its prevention suggested in the hope that increased awareness and understanding will reduce the incidence and complications of this potentially life-threatening condition.

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Risk factors for thiazide-induced hyponatraemia

Abstract: Hyponatraemia is a common problem after thiazide therapy. Extra caution and close monitoring are warranted when prescribing thiazides for elderly patients with low body mass.

Cited by 143 publications

References 43 publications

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

A comparative analysis of hydrochlorothiazide and chlorthalidone induced hyponatremia at the dose commonly prescribed in clinical practice

A review of thiazide-induced hyponatraemia

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