Syndrome of Inappropriate Antidiuretic Hormone Secretion Induced by Amiodarone Therapy

Aslam, Mohsin; Gnaim, Charlie; Kutnick, Jay; Kowal, Robert C.; McGuire, Darren K.

doi:10.1111/j.1540-8159.2004.00541.x

Cited by 17 publications

(6 citation statements)

References 3 publications

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“…In 1996, the first case of amiodarone-induced hyponatremia was reported [5]. Since then, a total of 10 cases of amiodarone-induced SIADH have been published in the literature (table 1; [6, 7, 8, 9, 10, 11, 12, 13]).…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia - A Rare but Serious Complication of Amiodarone: A Case Report and Review of the Literature

Pham

Shaer²,

Marnejon³

2013

Case Rep Nephrol Dial

298

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Introduction: Hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) during amiodarone therapy is a rare but potentially lethal adverse effect. We report a case of severe hyponatremia associated with amiodarone, and discuss its clinical implications. Case Report: An 84-year-old Caucasian man with a past medical history of hypertension and diabetes was admitted to the hospital with a non-ST elevation myocardial infarction. He underwent coronary artery bypass graft and developed atrial fibrillation on postoperative day 2. A loading dose of amiodarone followed by a maintenance dose was started. The serum sodium level was 136 mmol/l at discharge and subsequently decreased to 105 mmol/l 11 days later, at which time the patient represented with altered mental status. The diagnosis of SIADH was made based on euvolemic hypoosmotic hyponatremia, lack of any other medication known to cause SIADH and urine that was less than maximally dilute. The serum sodium increased gradually to 123 mmol/l after 36 h of treatment with hypertonic saline, demeclocycline and fluid restriction. Conclusion: SIADH-induced hyponatremia associated with amiodarone occurs rarely. Since severe hyponatremia is associated with significant neurological damage and mortality, clinicians should carefully monitor serum sodium during amiodarone therapy.

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Section: Discussionmentioning

confidence: 99%

Hyponatremia - A Rare but Serious Complication of Amiodarone: A Case Report and Review of the Literature

Pham

Shaer²,

Marnejon³

2013

Case Rep Nephrol Dial

298

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“…A review of the literature revealed four case reports of SIADH‐induced hyponatremia associated with amiodarone treatment between 1999 and 2004. In two of them, hyponatremia developed during the loading dose of amiodarone treatment and responded well to dose reduction without discontinuation of drug (1, 2). In one of these cases, the serum Na level was improved within 3 weeks of dose reduction (1).…”

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confidence: 99%

SIADH induced by amiodarone in a patient with heart failure

Paydaş

Araz

Balal

2008

International Journal of Clinical Practice

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A 58-year-old male patient with a history of hypertension presented with abdominal pain and nausea. Five months previously, he had presented with dyspnoea, abdominal fullness and pretibial oedema and was hospitalised in the coronary intensive care unit with the diagnosis of decompensated heart failure. At that time, renal function and serum sodium and potassium levels were completely normal. Low-dose aspirin, propranolol, nitrate, frusemide (furosemide), amiodarone and spironolactone were prescribed. At the last admission to our hospital, his body temperature was 36°C, blood pressure was 140 ⁄ 100 mm Hg, heart rate was 100 ⁄ min, regular. He was orientated and co-operative. Skin was normal, external jugular veins were not engorged. On auscultation of chest, there were bilateral crepitations. The heart was tachycardic and arrhythmic with no murmurs heard. No organomegaly or tenderness were found. Peripheral pulses were palpable in all extremities; there was no pretibial oedema. Laboratory findings were as follows: white blood cell, 11.900; haematocrit, 42.1; MCV, 83.9; platelets, 278.000; serum Na, 107 mEq ⁄ l; serum K, 4.1 mEq ⁄ l; blood urea nitrogen, 14 mg ⁄ dl; Creatinine, 1.0 mg ⁄ dl; total protein, 7.1 g ⁄ dl; albumin, 4.5 g ⁄ dl; TSH 0.76; free T3, 2.8; free T4, 2.6; CRP 3.1; uric acid, 2.7 mg ⁄ dl; AST, 36 IU ⁄ l; ALT, 32 IU ⁄ l; LDH, 499; urinary Na, 31 mEq ⁄ l; urinary osmolarity, 677. Blood lipids were within normal limits. On ultrasound, both kidneys were within the normal range with a simple renal cyst on the left kidney. There was mucosal thickening of the bladder wall with increased trabeculation. On transthoracic echocardiography, ejection fraction (EF) was 63% with dilatation of left atrial, right atrial and ventricular, 1 ⁄ 2 mitral regurgitation, 1 ⁄ 2 tricuspid regurgitation and mild pulmonary hypertension.Our primary diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) was based on hyponatremia, high urinary osmolarity, high-normal urinary Na, hypouric acidemia and absence of hypervolemia. But the aetiology was not apparent. Limiting the water and salt intake did not correct the serum Na level. Although malignancy was a well-known cause of SIADH, there was no abnormality on routine X-ray and ultrasound to suggest further examinations, such as CT or MR scanning. With the suspicion of druginduced SIADH, we discontinued amiodarone and observed the patient. Because he was asymptomatic, we discharged him with serum Na of 117 mEq ⁄ l. One and two weeks later in the outpatient clinic, serum Na levels were 123 and 130 mEq ⁄ l, respectively.A review of the literature revealed four case reports of SIADH-induced hyponatremia associated with amiodarone treatment between 1999 and 2004. In two of them, hyponatremia developed during the loading dose of amiodarone treatment and responded well to dose reduction without discontinuation of drug (1, 2). In one of these cases, the serum Na level was improved within 3 weeks of dose reduction (1). In a 67-year-old male patient with multiple ...

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“…One of the patients who was managed only with dose reduction developed recurrence of hyponatremia after reloading with amiodarone. 12 In that case, the hyponatremia improved and eventually resolved again after resuming the previous dose of amiodarone.…”

Section: Discussionmentioning

confidence: 87%

“…In the published medical literature, only 17 cases of amiodarone-induced hyponatremia have been reported, to our knowledge (Table 3). [8][9][10][11][12][13][14][15][16][17][18][19][20][21] The affected patients were predominantly male (n = 13) and elderly (range: 58-88 years, median: 68 years). Either atrial fibrillation or ventricular arrhythmia was the indication to start amiodarone in all 17 cases.…”

Section: Discussionmentioning

confidence: 99%