Severe Electrolyte Disturbances Complicated by Seizures and Acute Kidney Injury Within 10 Days of Starting Indapamide

Abstract

Indapamide is one of the most effective and well-known anti-hypertensive medications. Electrolyte disturbances have been classically recognized as a typical side effect profile of indapamide. The most common electrolyte imbalance described with indapamide was hypokalemia; however, hyponatremia is being increasingly reported. In this case, we report a unique form of severe electrolytes derangement (hyponatremia, hypokalemia, hypophosphatemia, and hypocalcemia), which was complicated by seizures, rhabdomyolysis, and acute kidney injury that occurred within only 10 days of indapamide initiation. The patient was admitted to the medical intensive care unit for prompt electrolyte replacement and close monitoring. With the discontinuation of indapamide and the prompt replacement of the deficient electrolytes, the patient's condition has improved dramatically, and he was discharged in a good state of health. Electrolyte disturbances are expected to be seen with indapamide usage, and it might be associated with severe consequences like arrhythmias and seizures. This case report would raise awareness and add to the importance of closely following patients after prescribing indapamide.

Association between Food/UGT2B7 Polymorphisms and Pharmacokinetics/Pharmacodynamics Properties of Indapamide in Healthy Humans

“…Twenty-six subjects out of forty-nine (twelve under fasted condition and fourteen under fed condition) showed different indapamide-related mild side effects. The reported side effects coincided with what was mentioned in the literature [31].…”

Non-convulsive status epilepticus possibly induced by a rapid correction of severe hyperkalemia: a case report and literature review

“…We might have encountered rare symptoms in the central nervous system in our case because we were able to appropriately decrease potassium concentrations, despite extremely severe hyperkalemia, without the occurrence of fatal arrhythmias or muscle paralysis. Furthermore, although previous reports indicate that more than one electrolyte disturbance can occasionally coexist in clinical settings [ 9 , 58 ], our case had no other electrolyte disturbances except for potassium abnormality; this finding highlights the association between potassium abnormality and NCSE in this case.…”

“…Electrolyte disturbances such as hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, and alkalosis are all associated with seizures [ 57 ]. Unlike other electrolyte disturbances, potassium abnormality rarely causes symptoms in the central nervous system, and there are only a few reports of epilepsy or seizures accompanying potassium abnormalities [ 9 , 58 , 59 ]. Nardone et al [ 59 ] indicated that severe potassium abnormalities may provoke fatal arrhythmias or muscle paralysis before central nervous system symptoms appear.…”

Decreased serum phosphate levels are a useful biomarker to predict occurrence and severity of cytokine release syndrome in chimeric antigen receptor T‐cell therapy

“…4 Moreover, the severe hypophosphataemia documented in this study suggests the importance of sufficient supply to prevent muscle weakness, seizures, and heart failure. 5,6 In order to speculate about the biological mechanism between the serum iP decrease and CRS, we performed comprehensive urine analyses and found that the cause of the serum iP decrease was increased renal excretion due to decreased renal resorption. Hyperinflammatory states such as sepsis and viraemia, induce excessive excretion of iP and hypophosphataemia, due to massive production of serum interleukin 6 (IL-6) and IL-6-induced elevation of FGF23.…”

“… 4 Moreover, the severe hypophosphataemia documented in this study suggests the importance of sufficient supply to prevent muscle weakness, seizures, and heart failure. 5 , 6 …”