Hyponatremia induced by drugs

Abstract

Medications make up one of the most frequent causes of hyponatremia. They may induce hyponatremia by affecting either the sodium and water homeostasis (diuretics) or the water homeostasis due to the syndrome of inappropriate secretion of antidiuretic hormone. Certain drugs (e.g., diuretics, psychotropic medications, anticonvulsants) have been implicated as established causes of hyponatremia. However, hyponatremia infrequently develops in the course of treatment with drugs used in everyday clinical practice including proton pump inhibitors, antibiotics, angiotensin-converting enzyme inhibitors, hypoglycemic agents and amiodarone. Proper diagnostic approach of patients with low serum sodium concentrations should involve a detailed medical history with special attention to the use of culprit medications. In cases of drug-induced hyponatremia, discontinuation of therapy with these agents and avoidance of readministration is fully warranted given that even mild hyponatremia can have adverse outcomes (increased mortality, cognition impairment, high risk of falls and fractures).