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A Review of Drug-Induced Hyponatremia

      Hyponatremia (defined as a serum sodium level < 134 mmol/L) is the most common electrolyte abnormality in hospitalized patients. Certain drugs (eg, diuretics, antidepressants, and antiepileptics) have been implicated as established causes of either asymptomatic or symptomatic hyponatremia. However, hyponatremia occasionally may develop in the course of treatment with drugs used in everyday clinical practice (eg, newer antihypertensive agents, antibiotics, and proton pump inhibitors). Physicians may not always give proper attention in time to undesirable drug-induced hyponatremia. Effective clinical management can be handled through awareness of the adverse effect of certain pharmaceutical compounds on serum sodium levels. Here, we review clinical information about the incidence of hyponatremia associated with specific drug treatment and discuss the underlying pathophysiologic mechanisms.

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      Linked Article

      • Drug-Induced Hyponatremia: Adding to the List
        American Journal of Kidney DiseasesVol. 52Issue 5
        • Preview
          In the excellent review of drug-induced hyponatremia, Liamis et al1 gave clinical information about the incidence of hyponatremia associated with specific drug treatment and discussed the underlying pathophysiological mechanisms. They also presented rare causes of drug-induced hyponatremia derived from occasionally reported cases. However, many drugs were not included in the investigators' list of medications that cause hyponatremia. Nicotine patch therapy can induce hyponatremia. The proposed mechanism is a possible syndrome of inappropriate antidiuretic hormone (SIADH) induced by this drug.
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      • In Reply to ‘Drug-Induced Hyponatremia Adding to the List’ and ‘Tramadol-Induced Hyponatremia’
        American Journal of Kidney DiseasesVol. 52Issue 5
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          The list of drugs that have been occasionally associated with hyponatremia is long1 and is getting longer with more recent reports, including 1 implicating sibutramine, a serotonin reuptake inhibitor used in the treatment of obesity.2 We agree with both Dr Ben Salem and colleagues3 and Dr Sarrett et al4 that the list of rare causes of drug-induced hyponatremia must be supplemented. This supplementary list of drugs sporadically reported as culprits of hyponatremia is shown in Box 1. The syndrome of inappropriate antidiuretic hormone secretion is implicated in the pathogenesis of most cases.
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