Severe Hyponatremia Is Often Drug Induced: 10‐Year Results of a Prospective Pharmacovigilance Program

Ramírez, Elena; Rodríguez, Anaís García; Queiruga, Javier; García, Irene García; Díaz, Laura; Martínez, Lucía; Muñoz, Raúl; Muñoz, M.; Tong, Hoi Y.; Martínez, José C.; Borobia, Alberto M.; Carcas, Antonio J.; Frías, Jesús

doi:10.1002/cpt.1562

Cited by 26 publications

(30 citation statements)

References 47 publications

(48 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The authors acknowledged that PPIinduced hyponatremia is infrequently reported and that their results possibly reflect the high prevalence of PPI prescribing in older hospitalized patients [9]. In other studies, PPI-induced hyponatremia has been reported as a rare cause of drug-induced hyponatremia [6,10]. Unfortunately, we cannot exclude pseudohyponatremia in this case completely.…”

Section: Discussionmentioning

confidence: 65%

“…Hyponatremia can often be attributed to medication use [6]. In particular, diuretics (thiazide and thiazide-like drugs) and nervous system drugs (antidepressants, antipsychotic agents, and antiepileptic agents) are known to cause hyponatremia [6].…”

Section: Introductionmentioning

confidence: 99%

“…Proton pump inhibitor (PPI)-induced hyponatremia is not reported frequently [6]. However, because PPIs are prescribed worldwide on a large scale, even rare side effects may have implications for clinical practice.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

2020

View full text Add to dashboard Cite

Background: Hyponatremia is the most common electrolyte disorder. Thiazides, antidepressants, antipsychotic drugs, and antiepileptic drugs are well-known causes of hyponatremia. Proton pump inhibitor use is a rare cause of hyponatremia and, when reported, it is due to one specific proton pump inhibitor, mostly omeprazole. Case presentation: A 67-year-old Caucasian male was referred to our outpatient clinic because of hyponatremia (127 mmol/L) found at routine laboratory examination. He had consulted his general practitioner because of abdominal pains. No other symptoms were present. At physical examination, he appeared euvolemic and had no abdominal tenderness. Besides omeprazole for reflux esophagitis he used no medication. Additional laboratory results included: serum osmolarity 274 mOsmol/kg, urinary osmolarity 570 mOsmol/kg, and urinary sodium 35 mmol/L. Other causes of hyponatremia were excluded and we diagnosed hyponatremia due to the syndrome of inappropriate antidiuretic hormone secretion secondary to use of omeprazole. Omeprazole was replaced by ranitidine after which his serum sodium levels normalized to 135 mmol/L. During follow-up, because of persistent reflux complaints despite ranitidine use, ranitidine was switched to another proton pump inhibitor: pantoprazole. After this intervention, his serum sodium level declined again to 133 mmol/L. We concluded that both omeprazole and pantoprazole induced syndrome of inappropriate antidiuretic hormone secretion in this patient. Conclusion: Hyponatremia is worrisome and awareness of medication-induced hyponatremia, especially due to proton pump inhibitors, is needed. In our case, sequential hyponatremia occurred with two different proton pump inhibitors, suggesting a class effect. Therefore, when syndrome of inappropriate antidiuretic hormone secretion due to a proton pump inhibitor is diagnosed, preferably no other medication from the same class is prescribed. When after consideration another proton pump inhibitor is prescribed, serum sodium concentrations should be monitored.

show abstract

Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

2020

View full text Add to dashboard Cite

show abstract

“…10,11,12,13 Thrombocytopenia, anemia, leukocytes in cerebrospinal fluid, pancreatitis, acute kidney injury, and hyponatremia are increasingly frequent druginduced reactions. 14,15,16,17,18,19 This study enabled us to detect a relevant number of ALSs that are potentially related to SADRs and to determine their in-hospital incidence. During March-April 2020, there was a significant 72% reduction in the number of spontaneous SADRs (not from the PPLSH) compared with the same period in 2019, although 4 drug reactions with eosinophilia and systemic symptoms, 2 cases of Stevens Johnson syndrome, and 1 case of acute generalized exanthematous pustulosis were included.…”

Section: Discussionmentioning

confidence: 99%

<strong>Suspected Serious Adverse Drug Reactions in Hospitalized COVID-19 Patients</strong>

Ramı́rez¹,

Urroz²,

Mariblanca³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

BACKGROUND: From March to April 2020, Spain was the center of the SARS-CoV-2 pandemic, particularly Madrid with approximately 30% of the cases in Spain. The aim of this study is to report the suspected serious adverse drug reactions (SADRs) in COVID-19 patients versus non-COVID-19 patients detected by the prospective pharmacovigilance program based on automatic laboratory signals (ALSs) in the hospital (PPLSH) during that period. We also compared the results with the suspected SADRs detected during the same period for 2019. METHODS: All ALSs that reflected potential SADRs (including neutropenia, pancytopenia, thrombocytopenia, anemia, eosinophilia, leukocytes in cerebrospinal fluid, hepatitis, pancreatitis, acute kidney injury, rhabdomyolysis and hyponatremia were prospectively monitored in hospitalized patients during the study periods. We analyzed the incidence and the distribution of causative drugs for the COVID-19 patients. RESULTS: The incidence rate of SADRs detected in the COVID-19 patients was 760.63 (95% CI 707.89–816.01) per 10,000 patients, 4.75-fold higher than the SADR rate for non-COVID-19 patients (160.15 per 10,000 patients,95% CI 137.09–186.80), and 5.84-fold higher than the SADR rate detected for the same period in 2019 (130.19 per 10,000 patients, 95% CI 109.53–154.36). The most frequently related drugs were tocilizumab (59.84%), dexketoprofen (13.93%), azithromycin (8.43%), lopinavir-ritonavir (7.35%), dexamethasone (7.62%), and chloroquine/hydroxychloroquine (6.91%). CONCLUSIONS: The incidence rate of SADRs detected by the PPSLH in patients with COVID-19 was 4.75-fold higher than that of the non-COVID-19 patients. Caution is recommended when using medications for COVID-19 patients, especially drugs that are hepatotoxic, myotoxic, and those that induce thromboembolic events.

show abstract

“…Hyponatremia is the most common electrolyte disorder among hospitalized patients, particularly among the elderly and women, and in the presence of comorbidities [1][2][3][4][5][6]. Its prevalence varies from 8% to 51%, and it often occurs as an acute disease complication, as a chronic disease decompensation, or as a consequence of interventions during patient treatment [1,5,6]. Hyponatremia is a predictor of poor prognosis in various diseases, including heart failure, coronary syndrome, liver cirrhosis, chronic kidney disease, and stroke [3,5,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Impact of Hyponatremia on COPD Exacerbation Prognosis

García-Sanz¹,

Martínez-Gestoso²,

Calvo-Álvarez

et al. 2020

JCM

View full text Add to dashboard Cite

The most common electrolyte disorder among hospitalized patients, hyponatremia is a predictor of poor prognosis in various diseases. The aim of this study was to establish the prevalence of hyponatremia in patients admitted for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), as well as its association with poor clinical progress. Prospective observational study carried out from 1 October 2016 to 1 October 2018 in the following hospitals: Salnés in Vilagarcía de Arousa, Arquitecto Marcide in Ferrol, and the University Hospital Complex of Santiago de Compostela, Galicia, Spain, on patients admitted for AECOPD. Patient baseline treatment was identified, including hyponatremia-inducing drugs. Poor progress was defined as follows: prolonged stay, death during hospitalization, or readmission within one month after the index episode discharge. 602 patients were enrolled, 65 cases of hyponatremia (10.8%) were recorded, all of a mild nature (mean 131.6; SD 2.67). Of all the patients, 362 (60%) showed poor progress: 18 (3%) died at admission; 327 (54.3%) had a prolonged stay; and 91 (15.1%) were readmitted within one month after discharge. Patients with hyponatremia had a more frequent history of atrial fibrillation (AF) (p 0.005), pleural effusion (p 0.01), and prolonged stay (p 0.01). The factors independently associated with poor progress were hyponatremia, pneumonia, and not receiving home O2 treatment prior to admission. Hyponatremia is relatively frequent in patients admitted for AECOPD, and it has important prognostic implications, even when mild in nature.

show abstract

Severe Hyponatremia Is Often Drug Induced: 10‐Year Results of a Prospective Pharmacovigilance Program

Cited by 26 publications

References 47 publications

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

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

<strong>Suspected Serious Adverse Drug Reactions in Hospitalized COVID-19 Patients</strong>

Impact of Hyponatremia on COPD Exacerbation Prognosis

Contact Info

Product

Resources

About