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Clinical CommentaryDiuretic-induced Severe Hyponatremia: Review and Analysis of 129 Reported Patients
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MATERIALS AND METHODS
The English-language literature during the years from 1962 to 1990 has been reviewed through a personal search and MEDLINE facilities.1, 2, 8, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57 Included in the study are 14 of our cases which have been reported in other contexts.51, 57 Reports were included in the study if serum sodium levels were equal to or below 115
Personal Series
Table 1 summarizes some of the characteristics of our patients with diuretic-induced severe hyponatremia. The mean age of the patients was 78 years. There were nine women and five men. All of the patients were treated with doses of diuretics within the limits of the pharmacologic recommendations. All of the patients who were receiving thiazides, but one had laboratory findings consistent with excess ADH activity, whereas none of the patients receiving furosemide had these findings. In 10 of the
DISCUSSION
From a review of the literature referring to serumsodium levels of less than 115 mEq/L, the various types of thiazides were found to be the major cause for diuretic-induced hyponatremia. In contrast, only seven cases of severe hyponatremia were reported to be caused by furosemide. Since furosemide is a more powerful natriuretic agent than the commonly used thiazides and since it is used in practice as much as thiazides, why does severe hyponatremia develop more with the latter? One indication
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Manuscript revision accepted June 23.