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Abstract：
OBJECTIVE: Hyponatraemia is one of the major adverse effects of thiazide and thiazide-like diuretics and the leading cause of drug-induced hyponatraemia requiring hospital admission. We sought to review and analyze all published cases of this important condition.
METHODS: Ovid Medline, Embase, Web of Science and PubMed electronic databases were searched to identify all relevant articles published before October 2013. A proportions meta-analysis was undertaken.
RESULTS: One hundred and two articles were identified of which 49 were single patient case reports. Meta-analysis showed that mean age was 75 (95% CI 73, 77) years, 79% were women (95% CI 74, 82) and mean body mass index was 25 (95% CI 20, 30) kg m(-2) . Presentation with thiazide-induced hyponatraemia occurred a mean of 19 (95% CI 8, 30) days after starting treatment, with mean trough serum sodium concentration of 116 (95% CI 113, 120) mm and serum potassium of 3.3 (95% CI 3.0, 3.5) mm. Mean urinary sodium concentration was 64 mm (95% CI 47, 81). The most frequently reported drugs were hydrochlorothiazide, indapamide and bendroflumethiazide.
CONCLUSIONS: Patients with thiazide-induced hyponatraemia were characterized by advanced age, female gender, inappropriate saliuresis and mild hypokalaemia. Low BMI was not found to be a significant risk factor, despite previous suggestions. The time from thiazide initiation to presentation with hyponatraemia suggests that the recommended practice of performing a single investigation of serum biochemistry 7-14 days after thiazide initiation may be insufficient or suboptimal. Further larger and more systematic studies of thiazide-induced hyponatraemia are required.
METHODS: Ovid Medline, Embase, Web of Science and PubMed electronic databases were searched to identify all relevant articles published before October 2013. A proportions meta-analysis was undertaken.
RESULTS: One hundred and two articles were identified of which 49 were single patient case reports. Meta-analysis showed that mean age was 75 (95% CI 73, 77) years, 79% were women (95% CI 74, 82) and mean body mass index was 25 (95% CI 20, 30) kg m(-2) . Presentation with thiazide-induced hyponatraemia occurred a mean of 19 (95% CI 8, 30) days after starting treatment, with mean trough serum sodium concentration of 116 (95% CI 113, 120) mm and serum potassium of 3.3 (95% CI 3.0, 3.5) mm. Mean urinary sodium concentration was 64 mm (95% CI 47, 81). The most frequently reported drugs were hydrochlorothiazide, indapamide and bendroflumethiazide.
CONCLUSIONS: Patients with thiazide-induced hyponatraemia were characterized by advanced age, female gender, inappropriate saliuresis and mild hypokalaemia. Low BMI was not found to be a significant risk factor, despite previous suggestions. The time from thiazide initiation to presentation with hyponatraemia suggests that the recommended practice of performing a single investigation of serum biochemistry 7-14 days after thiazide initiation may be insufficient or suboptimal. Further larger and more systematic studies of thiazide-induced hyponatraemia are required.
摘要：
目的：低钠血症是噻嗪类和噻嗪类利尿剂的主要不良反应之一，也是需要住院的药物性低钠血症的主要原因。我们试图审查和分析这一重要状况的所有已发表病例。
方法：OvidMedline，Embase,搜索WebofScience和PubMed电子数据库，以识别2013年10月之前发表的所有相关文章。进行了比例荟萃分析。
结果：确认了一百零二篇文章，其中49篇为单例病例报告。Meta分析显示，平均年龄为75(95%CI73,77)岁，79％为女性（95％CI74，82），平均体重指数为25（95％CI20，30）kgm（-2）。噻嗪类药物诱导的低钠血症在开始治疗后平均出现19天（95％CI8，30），平均谷血清钠浓度为116（95％CI113，120）mm，血清钾浓度为3.3（95％CI3.0，3.5）mm。平均尿钠浓度为64mm（95％CI47，81）。最常见的药物是氢氯噻嗪，茚达帕胺和苯并氟甲肼。
结论：噻嗪类药物引起的低钠血症患者的特征是高龄，女性性别,不适当的遗尿和轻度低钾血症。低BMI没有发现是一个显著的危险因素，尽管以前的建议。从噻嗪类药物开始到出现低钠血症的时间表明，在噻嗪类药物开始后7-14天进行一次血清生物化学研究的推荐做法可能不足或不理想。需要进一步对噻嗪引起的低钠血症进行更大规模和更系统的研究。
方法：OvidMedline，Embase,搜索WebofScience和PubMed电子数据库，以识别2013年10月之前发表的所有相关文章。进行了比例荟萃分析。
结果：确认了一百零二篇文章，其中49篇为单例病例报告。Meta分析显示，平均年龄为75(95%CI73,77)岁，79％为女性（95％CI74，82），平均体重指数为25（95％CI20，30）kgm（-2）。噻嗪类药物诱导的低钠血症在开始治疗后平均出现19天（95％CI8，30），平均谷血清钠浓度为116（95％CI113，120）mm，血清钾浓度为3.3（95％CI3.0，3.5）mm。平均尿钠浓度为64mm（95％CI47，81）。最常见的药物是氢氯噻嗪，茚达帕胺和苯并氟甲肼。
结论：噻嗪类药物引起的低钠血症患者的特征是高龄，女性性别,不适当的遗尿和轻度低钾血症。低BMI没有发现是一个显著的危险因素，尽管以前的建议。从噻嗪类药物开始到出现低钠血症的时间表明，在噻嗪类药物开始后7-14天进行一次血清生物化学研究的推荐做法可能不足或不理想。需要进一步对噻嗪引起的低钠血症进行更大规模和更系统的研究。
