Diuretics-induced Hyponatremia A Systematic Review Of The Published Evidence

BackgroundDiuretics prescription seems to be increasing after the guidelinesrecommending diuretics as first-line treatment of hypertension have beenintroduced. A number of studies has found that diuretics can causehyponatremia, and the prevalence rate can reach30%. The patients whoseillness is lighter may be no obvious symptoms, but the patients that seriouscan experience coma and even death. People always pay more attention tothe hypokalemia、hypomagnesemia、hyperuricemia or the disturbance ofcarbohydrate metabolism that induced by diuretics. The clinical doctors didnot pay enough attention to the hyponatremia.ObjectiveTo explore the susceptible factors and clinical features of diureticsinduced hyponatremia,and promote to use the diuretics in more safety andeffectively way.MethodsWe retrieved MEDLINE、Ovid、CNKI、Vip Database for articles about the diuretics induced hyponatremia. Searches were limited to Chinese/English-language publications.A causality assessment of diuretics andhyponatremia was performed on all case reports using Naranjo adversedrug reaction probability scale. Pearson correlational analysis wasperformed to assess correlations between the ccumulative dose of diureticsand serum sodium level.ResultsWe included8studies and31case repors,it contains6retrospectivestudies and2prospective studies. The Naranjo score of the cases is five orsix. The correlation intensity is very possible. The pearson correlationcoefficient of the ccumulative dose and serum sodium level is-0.121，P=0.757.We did not find significant correlations between the ccumulativedose of diuretics and the serum sodium levels. In addition, the major riskfactors of diuretics-induced hyponatremia are age、lower body weight、women, taking ACEI、ARB、SSRI or antidepressants, or accompanied byhyperlipemia, hypokalemia, gastroesophageal reflux disease, type2diabetes, diseases such as urinary tract infection, a history of diureticsinduced hyponatremia.ConclusionHyponatremia is a common problem after diuretics therapy.The timeof onset can be long or short. The clinical manifestations are nausea,vomiting, fatigue,and patients with acute severe hyponatremia can appear low sodium encephalopathy performance such as dizziness, disturbance ofconsciousness and convulsions, fall. When clinicians use diuretics,especially in patients with high-risk factors,extra caution and closemonitoring are warranted.