Hydrochlorothiazide
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Hyponatraemia and SIADH in an elderly patient with urinary retention: case report An 80-year-old man with hypertension and urinary retention developed hyponatraemia with syndrome of inappropriate antidiuretic hormone (SIADH) while receiving hydrochlorothiazide. The man, who had undergone transurethral resection one year earlier, started treatment with hydrochlorothiazide 25mg [frequency of administration not stated]; at that time, he also eliminated salt from his diet and started consuming 2–3 gallons (7.6–11.4L) of water per day. Two weeks after starting hydrochlorothiazide, he presented with dizziness, lower abdominal pain, a single episode of emesis and a 1-day history of urination difficulty with frequent urinary dribbling. His serum sodium level was 120 mEq/L, he had suprapubic fullness and he appeared fatigued. An attempt at urination was unsuccessful, and an indwelling urinary catheter was inserted with a bladder residual volume of 1500mL. Normal saline was administered and he was hospitalised. Hydrochlorothiazide was discontinued, and the man was placed on free water restriction. Laboratory findings were consistent with SIADH. His serum sodium level decreased further to 116 mEq/L, and demeclocycline was started. His serum sodium level increased slowly to 133 mEq/L and he became less fatigued with subtle cognitive improvements, and he was discharged. His sodium level remained normal one month later. Author comment: "Hyponatremia in this patient probably resulted from multiple etiologies, including diuretic use, low solute intake, excessive water intake, and perhaps urinary retention." Ezra N, et al. Clinical observation: hyponatremia associated with diuretic use and urinary retention in an older man. Journal of the American Geriatrics Society 57: 801156525 2353-2354, No. 12, Dec 2009 - USA
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Reactions 16 Jan 2010 No. 1284
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