Yamada Hodaka, Asano Tomoko, Aoki Atsushi, Ikoma Aki, Yoshida Masashi, Kusaka Ikuyo, Kawakami Masanobu, Kakei Masafumi, Ishikawa San-e
Division of Endocrinology and Metabolism, Saitama Medical Center, Jichi Medical University, Japan.
Intern Med. 2014;53(7):749-52. doi: 10.2169/internalmedicine.53.1738. Epub 2012 Mar 1.
Thiazide diuretics are known to produce severe hyponatremia as well as hypokalemia. The present study demonstrated severe hyponatremia in three hypertensive patients who had received combination therapy consisting of an angiotensin II receptor blocker (ARB) and thiazide. The serum sodium (Na) levels in all three cases were markedly reduced to below 116 mmol/L, and the patients exhibited augmented urinary excretion of Na with a reduced circulatory blood volume. After withdrawing the ARB and thiazide treatment, the serum Na levels normalized within one to two weeks. Combination therapy with ARBs and thiazide may cause hyponatremia in elderly patients.
已知噻嗪类利尿剂会导致严重低钠血症以及低钾血症。本研究表明，三名接受了由血管紧张素II受体阻滞剂（ARB）和噻嗪类组成的联合治疗的高血压患者出现了严重低钠血症。所有三例患者的血清钠（Na）水平均显著降至116 mmol/L以下，且患者表现出尿钠排泄增加，循环血容量减少。停用ARB和噻嗪类治疗后，血清钠水平在一至两周内恢复正常。ARB与噻嗪类的联合治疗可能会导致老年患者出现低钠血症。
