Tramadol‐induced hyponatraemia following unicompartmental knee replacement surgery

Udy, Andrew; Deacy, N.; Barnes, D.; Sigston, P.

doi:10.1111/j.1365-2044.2005.04260.x

Cited by 23 publications

(19 citation statements)

References 16 publications

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“…Four case reports have previously described hyponatremia in patients at least 70 years of age using tramadol at recommended dosages [2][3][4] . In each of these cases, hyponatremia occurred rapidly (between 2 to 9 days after initiation), was profound (<125 mmol/L), and was associated with clinical complications (confusion, falls, or seizures).…”

Section: Discussionmentioning

confidence: 99%

“…First, as previous case reports suggested the risk of hyponatremia typically occurred in the first 30 days of tramadol use. [3][4][5][6] Second, as alternate outcome definition, we used outpatient laboratory sodium serum test results in the 30 days after treatment initiation. For this analysis, we assessed the association between the use of tramadol and moderate hyponatremia (125 to 129 mmol/L), as well as the association with profound hyponatremia (<125 mmol/L).…”

Section: Secondary Analysesmentioning

confidence: 99%

“…Its use has increased steadily worldwide, including in the United States, where there has been a 1.5-fold increase in the dispensing of tramadol between 2007 and 2011 1 . In recent years however, there have been several case reports and a signal from a pharmacovigilance database that have associated the use of this opioid with hyponatremia, all of which occurred rapidly (within the first 30 days) after initiation [2][3][4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

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Tramadol for Noncancer Pain and the Risk of Hyponatremia

Fournier

Yin

Nessim

et al. 2015

The American Journal of Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Secondary Analysesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tramadol for Noncancer Pain and the Risk of Hyponatremia

Fournier

Yin

Nessim

et al. 2015

The American Journal of Medicine

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“…Opioids also inhibit the reuptake of neurotransmitters, such as noradrenaline (norepinephrine) and serotonin most prominently. Based on this information, Udy and colleagues presented a case of tramadol-induced hyponatraemia after unicompartmental knee replacement surgery (8).…”

Section: Discussionmentioning

confidence: 99%

Codeine-Induced Syndrome of Inappropriate Antidiuretic Hormone: Case Report

Karahan¹,

Karagöz²,

Erden³

et al. 2014

Balkan Med J

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The syndrome of inappropriate antidiuretic hormone (SI-ADH) was first described in 1957 by Schwartz and colleagues in two lung cancer cases that showed urinary sodium loss (1). SIADH is characterised by hyponatraemia, inappropriately increased urine osmolality, increased urine sodium, and decreased serum osmolality in a euvolemic patient without edema. Also, these findings should be considered in a patient with normal cardiac, renal, adrenal, hepatic, and thyroid functions and taking no diuretics. Excess water is the main problem in SIADH and therefore dilutional hyponatraemia develops (2).Codeine is an opioid analgesic used for moderate to severe pain. Its analgesic effect is dependent on the conversion to morphine and morphine-6-glucuronide because the binding affinity of codeine to µ (mu) opioid receptors is 200-fold less than that of morphine (3). Constipation and lethargy are frequent side effects. The side effect profile, such as nausea, vomiting, hypotension, tachycardia-bradycardia, confusion, imbalance, headache, dizziness, fatigue, urticaria, ureteral spasm, reduction in miction, and the very rarely seen tonicclonic seizures and respiratory depression is quite wide (4). However, some of the symptoms observed during the use of codeine such as nausea, vomiting, headache, fatigue, confusion, and seizures can also be the symptoms of hyponatraemia. In this case report, we present a SIADH patient with reduced urine volume, increased urine sodium, and decreased serum sodium concentration after using codeine-paracetamol combination medication, which is rarely encountered before, according to our review of the literature. CASE PRESENTATIONA previously healthy 77-year-old female of 82 kg in weight and 161 cm in height presented to the emergency service with a 3 to 4 day history of reduced amount of urine, nausea, vomiting, weakness, anorexia, dizziness, abdominal pain, constipation, and abdominal bloating. Fifteen days ago, she was admitted to the dermatology clinic for the vesicular and painful lesions on the right middle of the abdomen. She was prescribed hydroxyzine 25 mg tablets, topical mupirocin pomade, flurbiprofen tablets, and a combination of vitamin B1 and B6 pills for the diagnosis of herpes zoster; however, she used these medications only once because her pain was not resolved. After that, she used the combination of codeine phosphate 30 mg and paracetamol 500 mg, which is unused in our country and was brought by her son from abroad, for her painful lesions.On physical examination, the patient showed full cooperation and orientation. Her vital signs were as follows: temperature 36.6°C, heart rate: 102/minute, respiratory rate: 18/minute, and blood pressure: 107/82 mmHg. Her mucous membranes were wet; turgor and tonus were normal. She had Background: The syndrome of inappropriate antidiuretic hormone was first described in 1957 by Schwartz, and is characterised by hyponatraemia, inappropriately increased urine osmolality and urine sodium, and decreased serum osmolality in a euvolemic patient without e...

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“…Neuroendocrine tumors may cause hyponatremia. Narcotics have also been implicated as a cause of hyponatremia; one patient recovered from a narcotic-induced hyponatremia of 108 mEq/L [ 6 ]. We believe that hyponatremia in this patient was a result of her neuroendocrine tumor perhaps augmented by her use of narcotics.…”

Section: Case Presentationmentioning

confidence: 99%