Work

Thiazide-induced hyponatremia

Year: 2025

Type: article

Abstract: Thiazide diuretics are widely used antihypertensive agents, but their use can be complicated by thiazide-induced hyponatremia (TIH), a more common adverse effect than previously recognized. TIH may present acutely or chronically, with neurological symptoms varying by onset. Acute cases may require hypertonic saline, while chronic TIH is managed by discontinuing the thiazide, fluid restriction, and solute repletion. TIH appears to be idiosyncratic and is more common in older adults, those with low-normal plasma sodium and potassium levels, poor solute intake, or concurrent use of other hyponatremia-inducing drugs. TIH likely results from combined sodium and potassium depletion, increased water intake, and impaired water excretion, possibly involving prostaglandin E 2 or low solute intake. This review discusses new aspects of the epidemiology, clinical presentation, and mechanisms of TIH and offers guidance on its diagnosis and management. Emerging insights into renal and extra-renal thiazide targets may enhance the prediction of both therapeutic and adverse responses to these medications.

Source: Best Practice & Research Clinical Endocrinology & Metabolism

DOI: 10.1016/j.beem.2025.102063

Authors: Sebastian B. Beckmann, Crissy F. Rudolphi, Pedro H. Imenez Silva, Robert A. Fenton, Ewout J. Hoorn

Institutions: Erasmus MC, Aarhus University

Language: English

Topic: Electrolyte and hormonal disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,450