SGLT-2 Inhibitors to Treat Hyponatremia Associated with SIADH: A Novel Indication?

Sarafidis, Pantelis; Loutradis, Charalampos; Ferro, Charles J.; Ortíz, Alberto

doi:10.1159/000509082

Cited by 16 publications

(17 citation statements)

References 20 publications

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“…Patients with SIAD commonly have low protein intake; increasing daily protein intake to 1 g/kg improves hyponatremia by simulating urea therapy. Limited information suggests that empagliflozin, a sodium-glucose cotransporter-2 inhibitor, which promotes osmotic diuresis via glucosuria, may help management of SIAD …”

Section: Treatmentmentioning

confidence: 99%

Diagnosis and Management of Hyponatremia

Adrogué

Tucker

Madias

2022

JAMA

117

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Section: Treatmentmentioning

confidence: 99%

Diagnosis and Management of Hyponatremia

Adrogué

Tucker

Madias

2022

JAMA

117

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“…As glucosuria leads to osmotic diuresis and consequently increased free water excretion, the recent completion of the SAND and the DIVE trials has provided interesting data for the hypothesis that SGLT2i may help SIADH patients without significant adverse effects ( 7 , 8 ). However, these studies’ key limitations, including the absence of free-water clearance measurements, a very short treatment period, and the possibility of undiagnosed heart failures, suggest caution in using SGLT2i for SIADH ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…Accumulating evidence from major trials demonstrates that SGLT2i are potent cardio- and nephroprotective agents, offering reductions of up to 38% in cardiovascular mortality, 35% in heart failure hospitalization, 45% in the progression of renal disease, and 30% in all-cause mortality ( 2 ). Because of its beneficial effect on cardiovascular hemodynamics, SGLT2i, particularly dapagliflozin, has been recently approved by the Food and Drug Administration for heart failure treatment, even in patients without diabetes.…”

Section: Introductionmentioning

confidence: 99%

Canagliflozin-associated severe hyponatremia: a rare and potentially adverse effect?

Dhanasekaran

Narayanan

Mastoris

et al. 2022

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Sodium-glucose cotransporter-2 inhibitors (SGLT2i) induce osmotic diuresis by inhibiting the proximal renal tubular reabsorption of the filtered glucose load, which in turn can occasionally lead to severe dehydration and hypotension amidst other adverse effects. We present a case of a 49-year-old man with type 2 diabetes mellitus (T2D) on canagliflozin, a SGLT2i. The patient was brought to the emergency room following a motor vehicle accident. He was confused and had an altered mental status. His blood alcohol and urine toxicology screens were negative. Initial investigations revealed that he had severe hyponatremia with euglycemic ketoacidosis. The adverse condition was reversed with close monitoring and timely management, and the patient was eventually discharged. This is the first report to suggest hyponatremia as a potentially serious adverse effect following SGLT2i therapy. Its impact on the renal tubule handling of sodium and water is not yet well characterized. While further studies are warranted to understand better the pathophysiological mechanisms associated with SGLT2i-induced adverse effects, timely dose reduction or perhaps even its temporary discontinuation may be recommended to prevent complications. Learning points Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are usually well-tolerated, but some serious adverse effects have been documented. Our case report suggests hyponatremia as a potential, rare side effect of SGLT2i and makes physicians aware of the occurrence of such life-threatening but preventable complications. Timely and close monitoring of the patient, with temporary discontinuation of this drug, may be recommended towards effective management. Studies demonstrating a comprehensive understanding of SGLT2i-related electrolyte derangements are warranted.

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“…Para superar tal obstáculo sem utilizar via parenteral (solução hipertonia em bolus ou contínua), teríamos três opções clássicas: valptanos, formulações com ureia 16,17 ou sódio, 1,12,18,19 com as duas últimas alternativas seguras, eficazes e de custo muito inferior aos valptanos. Atualmente, os inibidores de SGLT2 também têm sido usados como uma forma segura de aumentar a excreção de água livre de soluto, em especial nos pacientes com SIADH, 20,21 mas não foi necessário no manejo do nosso paciente.…”

Section: Discussionunclassified

Suplementação Oral de Sódio: Uma Opção Segura no Manejo da SIADH

Filho¹

2022

RCHSI

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SGLT-2 Inhibitors to Treat Hyponatremia Associated with SIADH: A Novel Indication?

Cited by 16 publications

References 20 publications

Diagnosis and Management of Hyponatremia

Diagnosis and Management of Hyponatremia

Canagliflozin-associated severe hyponatremia: a rare and potentially adverse effect?

Suplementação Oral de Sódio: Uma Opção Segura no Manejo da SIADH

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