1/ #UncleBob has some thoughts about thiazide induced hyponatremia. I hope this takes less than #5goodminutes
Thiazides inhibit NaCl reabsorption in the DILUTING SEGMENT. This is the simple explanation for why patients can develop hyponatremia.
Thiazides inhibit NaCl reabsorption in the DILUTING SEGMENT. This is the simple explanation for why patients can develop hyponatremia.
https://twitter.com/inglisjosh/status/1258364843788169217
2/ Often there are other contributing factors. For example, if you have a borderline tea and toast diet (normal Na prior to starting the thiazide), the thiazide can unmask the dietary cause. The patient goes from a very dilute urine to much closer to isothenuria.
3/ In some patients, thiazides do result in volume contraction, and thus ADH stimulation, adding to the risk. I personally would be interested in the urine osms, but one can definitely treat empirically first.
4/ Treatment is tricky in this patient because once we remove the thiazide the patient can once again dilute their urine. If they have an excess of water, they could have a very significant water diuresis and thus the Na would rise too quickly.
5/ I would restrict fluids and check Na frequently. If the patient has an elevated urine osms, then we will need a more complex management. Given the very low sodium, we must be extremely careful. Please ask questions if I have not covered the explanations well.
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