"Critical Care A Day"
Saturday July 27, 2024
Saturday July 27, 2024
Q: Which group of diuretics tend to induce hyponatremia? (select one)
A) Loop
B) Thiazide
Answer: B
Thiazides are notorious for causing hyponatremia and typically occur within the first two weeks. It can be a challenging situation for a clinician since patients with thiazide-induced hyponatremia are usually clinically euvolemic and exhibit many of the features of inappropriate ADH secretion.
Hyponatremia rarely occurs with loop diuretics. This is because the inhibition of sodium chloride transport in the loop of Henle impairs the generation of the countercurrent gradient and, therefore, limits the ability of ADH to promote water retention. However, this should not be taken as a universal rule, as patients with CHF or cirrhosis may develop hyponatremia, as these disease processes are prone to cause hyponatremia or may be subject to over-diuresis.
#nephrology
#electrolytes
#pharmacology
References:
1. Filippone EJ, Ruzieh M, Foy A. Thiazide-Associated Hyponatremia: Clinical Manifestations and Pathophysiology. Am J Kidney Dis. 2020 Feb;75(2):256-264. doi: 10.1053/j.ajkd.2019.07.011. Epub 2019 Oct 9. PMID: 31606239.
2. Burst V, Grundmann F, Kubacki T, Greenberg A, Becker I, Rudolf D, Verbalis J. Thiazide-Associated Hyponatremia, Report of the Hyponatremia Registry: An Observational Multicenter International Study. Am J Nephrol. 2017;45(5):420-430. doi: 10.1159/000471493. Epub 2017 Apr 19. PMID: 28419981; PMCID: PMC5452281.
A) Loop
B) Thiazide
Answer: B
Thiazides are notorious for causing hyponatremia and typically occur within the first two weeks. It can be a challenging situation for a clinician since patients with thiazide-induced hyponatremia are usually clinically euvolemic and exhibit many of the features of inappropriate ADH secretion.
Hyponatremia rarely occurs with loop diuretics. This is because the inhibition of sodium chloride transport in the loop of Henle impairs the generation of the countercurrent gradient and, therefore, limits the ability of ADH to promote water retention. However, this should not be taken as a universal rule, as patients with CHF or cirrhosis may develop hyponatremia, as these disease processes are prone to cause hyponatremia or may be subject to over-diuresis.
#nephrology
#electrolytes
#pharmacology
References:
1. Filippone EJ, Ruzieh M, Foy A. Thiazide-Associated Hyponatremia: Clinical Manifestations and Pathophysiology. Am J Kidney Dis. 2020 Feb;75(2):256-264. doi: 10.1053/j.ajkd.2019.07.011. Epub 2019 Oct 9. PMID: 31606239.
2. Burst V, Grundmann F, Kubacki T, Greenberg A, Becker I, Rudolf D, Verbalis J. Thiazide-Associated Hyponatremia, Report of the Hyponatremia Registry: An Observational Multicenter International Study. Am J Nephrol. 2017;45(5):420-430. doi: 10.1159/000471493. Epub 2017 Apr 19. PMID: 28419981; PMCID: PMC5452281.