Opioid-induced hyponatremia in a patient with central diabetes insipidus: independence from ADH
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Nandini Bhat
Abstract
Hyponatremia can be a complication of opioid therapy, which has been postulated to occur secondary to inappropriate antidiuretic hormone secretion (syndrome of inappropriate antidiuretic hormone secretion [SIADH]). We report severe hyponatremia following wisdom teeth extraction with opioid analgesia in a 19-year-old female with diabetes insipidus (DI) and acquired panhypopituitarism that challenges this theory. As this patient has DI, we believe opioid treatment caused severe hyponatremia by the following mechanisms: (1) Opioids have a direct antidiuretic effect independent of changes in ADH, as demonstrated in Brattleboro rats with central DI. (2) Hydrocodone may have stimulated this patient’s thirst center contributing to hyponatremia, as demonstrated in animal studies. Opioid use can cause hyponatremia in patients independent of ADH. It is important for clinicians to be aware of this so that patients can be appropriately counseled.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Abadie D, Durrieu G, Roussin A, Montastruc JL. “Serious” adverse drug reactions with tramadol: a 2010–2011 pharmacovigilance survey in France. Therapie 2013;68: 77–84.10.2515/therapie/2013021Search in Google Scholar
2. Fournier JP, Yin H, Nessim SJ, Montastruc JL, Azoulay L. Tramadol for noncancer pain and the risk of hyponatremia. Am J Med 2015;128:418–25 e5.10.1016/j.amjmed.2014.10.046Search in Google Scholar
3. Udy A, Deacy N, Barnes D, Sigston P. Tramadol-induced hyponatraemia following unicompartmental knee replacement surgery. Anaesthesia 2005;60:814–6.10.1111/j.1365-2044.2005.04260.xSearch in Google Scholar
4. Mohan S, Gu S, Parikh A, Radhakrishnan J. Prevalence of hyponatremia and association with mortality: results from NHANES. Am J Med 2013;126:1127–37 e1.10.1016/j.amjmed.2013.07.021Search in Google Scholar
5. Karahan S, Karagoz H, Erden A, Avci D, Esmeray K. Codeine-induced syndrome of inappropriate antidiuretic hormone: case report. Balkan Med J 2014;31:107–9.10.5152/balkanmedj.2013.9424Search in Google Scholar
6. Cuesta M, Thompson CJ. The syndrome of inappropriate antidiuresis (SIAD). Best Pract Res Clin Endocrinol Metab 2016;30: 175–87.10.1016/j.beem.2016.02.009Search in Google Scholar
7. Day L, Kleinschmidt K, Forrester MB, Feng S-Y. Comparison of unintentional exposures to codeine and hydrocodone reported to Texas poison centers. J Emerg Med 2016;50:744–52.10.1016/j.jemermed.2016.01.023Search in Google Scholar
8. Bora F, Yilmaz F, Bora T. Ecstasy (MDMA) and its effects on kidneys and their treatment: a review. Iran J Basic Med Sci 2016;19:1151–8.Search in Google Scholar
9. Bichet DG. Genetics and diagnosis of central diabetes insipidus. Ann Endocrinol (Paris) 2012;73:117–27.10.1016/j.ando.2012.03.030Search in Google Scholar
10. Huidobro-Toro JP. Antidiuretic effect of beta endorphin and morphine in Brattleboro rats: development of tolerance and physcial dependence after chronic morphine treatment. Br J Pharmacol 1980;71:51–6.10.1111/j.1476-5381.1980.tb10908.xSearch in Google Scholar
11. Leander JD, Zerbe RL, Hart JC. Diuresis and suppression of vasopressin by kappa opioids: comparison with mu and delta opioids and clonidine. J Pharmacol Exp Ther 1985;234:463–9.Search in Google Scholar
12. Nishi R, Ueta Y, Serino R, Nomura M, Yamamoto Y, et al. Increase of vasopressin mRNA in the hypothalamus of inbred polydipsic mice. Brain Res Bull 1999;50:47–51.10.1016/S0361-9230(99)00082-9Search in Google Scholar
13. Tsumura K, Li X, Murdiastuti K, Parvin MN, Akamatsu T, et al. Downregulation of AQP2 expression in the kidney of polydipsic STR/N mice. Am J Physiol Renal Physiol 2006;290:F478–85.10.1152/ajprenal.00029.2005Search in Google Scholar
14. Nagatomo I, Katafuchi T, Koizumi K. Effects of the opiates on the paraventricular nucleus in genetically polydipsic mice. Brain Res 1992;598:23–32.10.1016/0006-8993(92)90163-4Search in Google Scholar
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- Oral administration of diluted nasal desmopressin in managing neonatal central diabetes insipidus
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- Evaluation of endocrine and metabolic dysfunctions after hematopoietic stem cell transplantation in children: a study from Turkey
- Case Reports
- Opioid-induced hyponatremia in a patient with central diabetes insipidus: independence from ADH
- Deoxyguanosine kinase deficiency: a report of four patients
- Fructose-1,6-bisphosphatase deficiency caused by a novel homozygous Alu element insertion in the FBP1 gene and delayed diagnosis
Articles in the same Issue
- Frontmatter
- Review
- Multiple effects of probiotics on different types of diabetes: a systematic review and meta-analysis of randomized, placebo-controlled trials
- Original Articles
- Oral administration of diluted nasal desmopressin in managing neonatal central diabetes insipidus
- Does body fat percentage predict post-exercise heart rate response in non-obese children and adolescents?
- The relationship between insulin resistance and endothelial dysfunction in obese adolescents
- Neck circumference is similarly predicting for impairment of glucose tolerance as classic anthropometric parameters among healthy and obese children and adolescents
- Reduced bone mineral density in Chinese children with phenylketonuria
- Assessment of stress levels in girls with central precocious puberty before and during long-acting gonadotropin-releasing hormone agonist treatment: a pilot study
- Association study of LIN28B in girls with precocious puberty
- Molecular genetics of growth hormone deficient children: correlation with auxology and response to first year of growth hormone therapy
- Evaluation of factors associated with elevated newborn 17-hydroxyprogesterone levels
- Evaluation of endocrine and metabolic dysfunctions after hematopoietic stem cell transplantation in children: a study from Turkey
- Case Reports
- Opioid-induced hyponatremia in a patient with central diabetes insipidus: independence from ADH
- Deoxyguanosine kinase deficiency: a report of four patients
- Fructose-1,6-bisphosphatase deficiency caused by a novel homozygous Alu element insertion in the FBP1 gene and delayed diagnosis
