Carbamazepine Induced Hyponatremia In Patients Essay

573 words - 3 pages

Carbamazepine-induced hyponatremia
Drug-induced hyponatremia is commonly associated with diuretics (frusemide, indapamide), selective serotonin reuptake inhibitors (sertraline, fluoxetine) and antiepileptics.[1] A 61-year-old female, 38 kg, was scheduled for debridement and superficial skin grafting for post-burn raw area in right arm. History and physical examination was unremarkable. Blood biochemistry was normal except for serum electrolytes; Na 128 mEq/L, K 4.3 mEq/L. The patient denied any recent history of diarrhoea or vomiting that could explain the low sodium. Repeat investigation was consistent with hyponatremia; serum Na 129 mEq/L. On close persistent questioning the patient admitted that she suffered from epilepsy and was taking carbamazepine regularly for the last 34 years. She had sustained burns during an epileptic fit. Her oral intake of salt was increased and fluid intake was restricted. On the day of surgery, serum electrolytes were normal (Na 142 mEq/L, K 4.1 mEq/L). Standard general anesthesia (thiopentone, fentanyl, midazolam, vecuronium with controlled ventilation via laryngeal mask airway) was administered and the patient had an uneventful recovery. The patient was explained about drug-induced low sodium and advised to consult her physician.
Carbamazepine (CBZ), an anticonvulsant and psychotropic drug, is used commonly for treatment of epilepsy, neuralgia, mental retardation and psychiatric disorders.[2] The incidence of hyponatremia (Na<134 mEq/L) in 451 CBZ-treated patients was 13.5% and that of severe hyponatremia ((Na<128 mEq/L)) was 2.8%.[3] Advanced age was a risk factor for hyponatremia.[3] Grand-mal seizure related to hyponatremia (Na 125 mEq/L) in a 54-year-old woman after six weeks of CBZ treatment has been reported.[4] Possible mechanisms for the anti-diuretic effects of CBZ include alteration in sensitivity or...

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