Drug-induced hyponatraemia
Drug-induced hyponatraemia occurs in approximately 5% of outpatients and 15% of inpatients. The commonest drugs causing hyponatraemia are: (1,2)
- desmopressin, oxytocin
- medications that stimulate vasopressin release or potentiate the effects of vasopressin: selective serotonin-reuptake inhibitors and most other antidepressants, morphine and other opioids
- medications that impair urinary dilution such as thiazide diuretics
- medications that cause hyponatraemia by an uncertain mechanism of action such as carbamazepine, vincristine, nicotine, antipsychotics, chlorpropamide, cyclophosphamide, non-steroidal anti-inflammatory drugs
- illicit drugs: MDMA or ecstasy causes vasopressin release, and has been associated with acute, life-threatening hyponatraemia
- bowel preparations for colonoscopy
Most patients with hyponatraemia are diagnosed incidentally on routine blood tests
Example causes of drug induced hyponatraemia:
Diuretics
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Anticonvulsants
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ACE inhibitor
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COX2 inhibitor
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Hypnotics
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Sulphonylureas
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Proton pump inhibitor
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Hormonal analogue
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Antidepressants
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Recreational drugs
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Reference:
- Adrogué HJ, Tucker BM, Madias NE. Diagnosis and management of hyponatremia: a review. JAMA. 2022 Jul 19;328(3):280-91.
- Grant P, Ayuk J, Bouloux PM, et al. The diagnosis and management of inpatient hyponatraemia and SIADH. Eur J Clin Invest. 2015 Aug;45(8):888-94.
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