Terbinafine
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Toxic hepatitis and hyponatraemia: case report A 58-year-old man developed toxic hepatitis and hyponatraemia during treatment with terbinafine. The man was hospitalised five weeks prior due to hyperglycaemia. Following blood glucose regulation, he was discharged and prescribed with terbinafine [route, dosage and indication not stated], atorvastatin, vildagliptin, pancreatin, domperidone and desloratadine. On follow-up, his liver enzymes were found to be elevated including direct bilirubin and total bilirubin. Also, his sodium level was dropped and jaundice was observed. He was admitted to hospital with a suspect diagnosis of acute hepatitis. His medical history revealed a previous encounter with terbinafine induced toxic hepatitis 6 years ago. He also had history of hyperlipidaemia, diabetes mellitus and onychomycosis. Due to his previous encounter, terbinafine induced toxic hepatitis was diagnosed along with euvolemic hyponatraemia. On follow-up, liver enzyme levels were found regressed, and laboratory tests revealed plasma renin activity, aldosterone, cortisol (fasting), sodium (24 hours in urine) and TSH were within the normal level. Serum osmolarity level was found to be elevated, where as, a osmotic gap of 18 [unit not stated] and a urine osmolarity of 618 mOsm/kg were found. The serum viscosity was found at 2.55 cP. Total protein, albumin/globulin ratio, and the lipid profile were re-examined and revealed the following: a total cholesterol of 1274 mg/dL, a LDL of 1160 mg/dL, a triglycerides of 208 mg/dL, a albumin of 2.90 g/dL and a total protein of 5.42 g/dL. Based on the findings, pseudohyponatraemia due to cholestatic liver injury related hypercholesterolaemia was considered. The man underwent lipid apheresis on 8 December 2018, which continued for 3 seasons. His sodium and lipid profile were found to be improved with abdominal pain regressed. Also, a significant decrease in alkaline phosphatase, gamma-glutamyltransferase, total bilirubin, direct bilirubin, total cholesterol and LDL and increase in sodium level was observed. During the follow-up, hyponatraemia and hypercholesterolaemia were not observed. Yesil B, et al. Toxic hepatitis and hyponatremia: Case report. Turkish Journal of Gastroenterology 30 (Suppl. 51-51): S51-S52 abstr. P-027, No. 1, Apr 2019. Available from: 803507295 URL: http://doi.org/10.5152/tjg.2019.33 [abstract]
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Reactions 17 Oct 2020 No. 1826
