Risk of Electrolyte Disorders, Syncope, and Falls in Patients Taking Thiazide Diuretics: Results of a Cross-Sectional Study

Ravioli, Svenja; Bahmad, Shawki; Funk, Georg; Schwarz, Christoph; Exadaktylos, Aristomenis K.; Lindner, Gregor

doi:10.1016/j.amjmed.2021.04.007

Cited by 33 publications

(21 citation statements)

References 26 publications

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“…The association of VD reflex syncope with chronic vasoactive drug therapy is a frequent clinical problem, especially in the elderly. The use of thiazides has been shown to be an independent predictor for syncope even after correction for age and the presence of hyponatremia and hypokalemia [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Cardioinhibitory syncope with asystole during nitroglycerin potentiated head up tilt test: prevalence and clinical predictors

et al. 2022

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Aims The aim of our study was to evaluate the prevalence and clinical predictors of cardioinhibitory (CI) responses with asystole at the nitroglycerin (NTG)-potentiated head-up tilt test (HUTT) in patients with a history of syncope admitted to a tertiary referral syncope unit. Methods We retrospectively evaluated all consecutive patients who underwent NTG-potentiated HUTT for suspected reflex syncope at our institution from March 1 2017 to May 1 2020. The prevalence of HUTT-induced CI syncope was assessed. Univariate and multivariate analyses were performed to test the association of asystolic response to HUTT with a set of clinical covariates. Results We enrolled 1285 patients (45 ± 19.1 years; 49.6% male); 368 (28.6%) showed HUTT-induced CI response with asystole. A multivariate analysis revealed that the following factors were independently associated with HUTT-induced CI syncope: male sex (OR 1.48; ConInt 1.14–1.92; P = 0.003), smoking (OR 2.22; ConInt 1.56–3.115; P < 0.001), traumatic syncope (OR: 2.81; ConInt 1.79–4.42; P < 0.001), situational syncope (OR 0.45; ConInt 0.27–0.73; P = 0.002), and the use of diuretics (OR 9.94; ConInt 3.83–25.76; P < 0.001). Conclusions The cardioinhibitory syncope with asystole induced by NTG-potentiated HUTT is more frequent than previously reported. The male gender, smoking habit, history of traumatic syncope, and use of diuretics were independent predictors of HUTT-induced CI responses. Conversely, the history of situational syncope seems to reduce this probability.

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Section: Discussionmentioning

confidence: 99%

Cardioinhibitory syncope with asystole during nitroglycerin potentiated head up tilt test: prevalence and clinical predictors

et al. 2022

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“…In reply to the letter from Pareek et al on our study 1 on the association between thiazide diuretic use and the prevalence of electrolyte disorders, syncope, and falls we would like to state the following: Our analysis of a large, real-life collective of patients clearly showed that thiazide diuretics were a strong risk factor for the presence of hyponatremia as well as hypokalemia. Of course, the study is a cross-sectional analysis and its results imply an association and not causality.…”

Section: The Replymentioning

confidence: 89%

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Lindner

Ravioli

2022

The American Journal of Medicine

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“…While hyponatremia has a broad spectrum of etiologies, of which the syndrome of inadequate antidiuretic hormone secretion, low effective circulating volume through heart failure or cirrhosis of the liver or diuretics are amongst the most common [ 11 , 12 ]. Hypernatremia in outpatients on the other hand, is mainly caused by an inadequate intake of electrolyte-free water, due to a lack of access or an impaired sense of thirst, caused by a central nervous system pathology, medication or intoxication [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Hypernatremia at presentation to the emergency department: a case series

2022

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Disorders of serum sodium are common findings in patients presenting to the emergency department (ED). The aim of this study was to systematically investigate the prevalence, symptoms, etiology, treatment as well as the course of hypernatremia present on admission to the ED. All adult patients with measurements of serum sodium presenting to the ED between 01 January 2017 and 31 December 2020 were included in this retrospective cohort study. Chart reviews were performed for all patients with hypernatremia defined as serum sodium > 147 mmol/L. 376 patients (0.7%) had a serum sodium > 145 mmol/L on admission and 109 patients (0.2%) had clinically relevant hypernatremia > 147 mmol/L. Main symptoms included somnolence (42%) followed by disorientation (30%) and recent falls (17%). An impaired sense of thirst was the main cause of hypernatremia as present in 76 patients (70%), followed by a lack of free access to water in 50 patients (46%). Regarding treatment, only one patient received targeted oral hydration and 38 patients (35%) experienced inadequate correction of hypernatremia as defined as either a correction of < 2 mmol/L or further increasing sodium during the first 24 h. 25% of patients with hypernatremia died during the course of their hospital stay. Patients who died had significantly lower correction rates of serum sodium (0 mmol/L (−3 − 1.5) versus − 6 mmol/L (−10 − 0), p < 0.001). Hypernatremia is regularly encountered in the ED and patients present with unspecific neurologic symptoms. Initial treatment and correction of hypernatremia are frequently inadequate with no decrease or even increase in serum sodium during the first 24 h.

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Risk of Electrolyte Disorders, Syncope, and Falls in Patients Taking Thiazide Diuretics: Results of a Cross-Sectional Study

Cited by 33 publications

References 26 publications

Cardioinhibitory syncope with asystole during nitroglycerin potentiated head up tilt test: prevalence and clinical predictors

Cardioinhibitory syncope with asystole during nitroglycerin potentiated head up tilt test: prevalence and clinical predictors

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Hypernatremia at presentation to the emergency department: a case series

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