Capinha Miguel, Lavrador Marta, Liberato Joana, Pinheiro Adriana, Aveiro Ana, Figueiredo Isabel Vitória, Castel-Branco Margarida
Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Polo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal.
Coimbra Institute for Clinical and Biomedical Research (iCBR), Polo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal.
J Clin Med. 2025 Sep 18;14(18):6584. doi: 10.3390/jcm14186584.
Hyponatremia (serum sodium concentration < 135 mmol/L) represents the most common electrolyte disturbance in clinical practice, particularly among high-risk populations such as older adults. Its severity ranges from moderately severe to life-threatening symptoms, contributing to increased mortality. Its etiology is widely heterogeneous and leads to different classifications according to volume status such as hypovolemic, euvolemic and hypervolemic hyponatremia. Drug-induced hyponatremia presents itself as one of the most prevalent but frequently overlooked causes, since many confounding factors like associated comorbidities and polypharmacy complicate the identification of specific medicines as the main offenders. : This narrative review was performed to provide a comprehensive analysis on drug-induced hyponatremia, focusing not only on the underlying pharmacological mechanisms, but also on management strategies in clinical practice. : A narrative literature review was conducted using PubMed, Science Direct and Google Scholar. : This narrative review focused not only on the most common drug classes to induce hyponatremia through different mechanisms, including diuretics, antidepressants, anticonvulsants, and antipsychotics, but also on other pharmacological classes, that, although to a lesser extent, might also be associated with decreasing serum sodium levels (antineoplastic and immunomodulating agents, drugs acting on digestive and locomotor systems, anti-infective drugs, endocrine diseases drugs, among others). It also explores recommendations on the management of drug-induced hyponatremia and it emphasizes the role of healthcare providers in addressing this electrolyte disorder. : As drug-induced hyponatremia poses significant challenges in clinical practice, understanding its mechanisms, coupled with effective management strategies, can enhance patient safety.
低钠血症（血清钠浓度<135 mmol/L）是临床实践中最常见的电解质紊乱，在老年人等高风险人群中尤为常见。其严重程度从中度严重到危及生命的症状不等，会导致死亡率增加。其病因广泛多样，根据容量状态可分为低血容量性、等血容量性和高血容量性低钠血症等不同类型。药物性低钠血症是最常见但常被忽视的病因之一，因为许多混杂因素，如合并症和多种药物联用，使确定特定药物为主要病因变得复杂。：本叙述性综述旨在对药物性低钠血症进行全面分析，不仅关注其潜在的药理机制，还关注临床实践中的管理策略。：使用PubMed、Science Direct和谷歌学术进行了叙述性文献综述。：本叙述性综述不仅关注通过不同机制导致低钠血症的最常见药物类别，包括利尿剂、抗抑郁药、抗惊厥药和抗精神病药，还关注其他药理类别，尽管程度较轻，但也可能与血清钠水平降低有关（抗肿瘤和免疫调节药物、作用于消化和运动系统的药物、抗感染药物、内分泌疾病药物等）。它还探讨了药物性低钠血症的管理建议，并强调了医疗服务提供者在处理这种电解质紊乱中的作用。：由于药物性低钠血症在临床实践中带来重大挑战，了解其机制并结合有效的管理策略可以提高患者安全性。
