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Thiazide-associated hyponatremia in the elderly： what the clinician needs to know

Journal of Geriatric Cardiology 2016年第2期13卷 175-182页

作者： george liamis Theodosios D Filippatos Moses S Elisaf Department of Internal Medicine School of Medicine University of loannina Ioannina Greece

Thiazide-induced hyponatremia is one of the main causes of decreased sodium levels in elderly individuals. This review presents the current evidence regarding the thiazide-associated hyponatremia. Thiazide-associated hyponatremia is observed mainly in patients with certain risk factors such as those receiving large doses of thiazides, having much comorbidity, such as heart failure, liver disease or malignancy, and taking several medications, such as non-steroidal anti-inflammatory drugs, selective serotonin re-uptake inhibitors or tricyclic antide- pressants. Sodium concentration should be monitored in patients with risk factors for developing thiazide-associated hyponatremia and clini- cians should measure promptly serum sodium levels in patients with neurologic signs indicating reduced sodium levels. The clinical and biochemical profile of patients with thiazide-associated hyponatremia may be that of extracellular volume depletion or the syndrome of inap- propriate antidiuretic hormone secretion （SIADH）. The investigation of possible thiazide-associated hyponatremia includes the exclusion of other causes of decreased sodium levels and the identification of the characteristics of hyponatremia due to thiazides （extracellular volume depletion-related or SIADH-like）. Treatment should be carefully monitored to avoid serious neurologic complications due to overcorrection. Clinicians should discourage prescribing thiazides in patients with a history of diuretic-associated hyponatremia and should prefer low doses of thiazides in patients with risk factors for developing thiazide-associated hyponatremia.

关键词： Antidiuretic hormone Diuretics Hyponatremia Potassium Sodium Thiazides

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Diabetes mellitus and electrolyte disorders

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World Journal of Clinical Cases 2014年第10期2卷 488-496页

作者： george liamis Evangelos Liberopoulos Fotios Barkas Moses Elisaf Department of Internal Medicine School of MedicineUniversity of IoanninaStavrou Niarchou Avenue45110 Ioannina Greece

Diabetic patients frequently develop a constellation of electrolyte disorders. These disturbances are particularly common in decompensated diabetics, especially in the context of diabetic ketoacidosis or nonketotic hyperglycemic hyperosmolar syndrome. These patients are markedly potassium-, magnesium- and phosphatedepleted. Diabetes mellitus(DM) is linked to both hypo- and hyper-natremia reflecting the coexistence of hyperglycemia-related mechanisms, which tend to change serum sodium to opposite directions. The most important causal factor of chronic hyperkalemia in diabetic individuals is the syndrome of hyporeninemic hypoaldosteronism. Impaired renal function, potassiumsparing drugs, hypertonicity and insulin deficiency are also involved in the development of hyperkalemia. This article provides an overview of the electrolyte disturbances occurring in DM and describes the underlying mechanisms. This insight should pave the way for pathophysiology-directed therapy, thus contributing to the avoidance of the several deleterious effects associated with electrolyte disorders and their treatment.

关键词： Glucose Osmotic diuresis Hyponatremia Hyperkalemia Hypomagnesemia

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Colonoscopy preparation-induced disorders in renal function and electrolytes

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2014年第2期5卷 50-54页

作者： Matilda Florentin george liamis Moses S Elisaf Department of Internal Medicine School of MedicineUniversity of Ioan-nina45110 IoanninaGreece

Colonoscopy and flexible sigmoidoscopy are commonly used mainly for colon cancer screening and detection, but also in several other situations such as inflammatory bowel disease (for diagnosis and follow up) and gastrointestinal hemorrhage. Bowel cleansing preparations mainly include polyethylene glycol and oral sodium phosphate solutions, with the later being most frequently used due to better toleration from patients. Despite their favourable safety profile these agents have been associated with renal function deterioration and electrolyte disorders, some of which were serious or even fatal. The present paper discusses the complications associated with colonoscopy preparation agents.

关键词： Oral sodium phosphate Hyperphosphatemia Hypocalcemia Phosphate nephropathy

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