Front Horm Res. 2019;52:167-177. doi: 10.1159/000493246. Epub 2019 Jan 15.
In clinical practice, several medications such as diuretics, psychotropic drugs, and anticonvulsants have been reported to be a frequent cause of hyponatremia. Drugs may cause hyponatremia either by affecting the homeostasis of sodium and water (e.g., diuretics) or by altering the water homeostasis as a consequence of the syndrome of inappropriate secretion of antidiuretic hormone. On the contrary, drugs commonly prescribed in everyday clinical practice, including proton pump inhibitors, antibiotics, angiotensin-converting enzyme inhibitors, hypoglycemic agents and, amiodarone, have been infrequently 'incriminated' as causes of hyponatremia. Therefore, in the diagnostic approach of patients with low serum [Na+] levels, meticulous history taking and recording of pharmacotherapy is warranted to identify potentially culprit medications. Taking into account the adverse outcomes associated with even mild hyponatremia (i.e., impaired cognition, falls and fractures, mortality), recognition of drug-induced hyponatremia is of vital importance, while responsible agents should be discontinued and "re-challenge" should be avoided by informing the patient and involved caregivers.
在临床实践中，利尿剂、精神药物和抗惊厥药等几种药物已被报道为导致低钠血症的常见原因。药物可通过影响钠和水的内环境平衡（例如利尿剂）或通过抗利尿激素分泌不当综合征导致水内环境平衡改变而引起低钠血症。相反，在日常临床实践中常用的药物，包括质子泵抑制剂、抗生素、血管紧张素转换酶抑制剂、降糖药和胺碘酮，很少被“归咎”为低钠血症的原因。因此，在对血清[Na+]水平低的患者进行诊断时，需要详细询问病史并记录药物治疗情况，以确定潜在的致病药物。考虑到即使是轻度低钠血症也会带来不良后果（即认知障碍、跌倒和骨折、死亡率），识别药物引起的低钠血症至关重要，应停用有责任的药物，并通过告知患者和相关护理人员来避免“再挑战”。
