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Anxiolytic treatment but not anxiety itself causes hyponatremia among anxious patients.

ABSTRACT: The aim of the study was to define whether anxiety itself or only the treatment with anxiolytic medication is risk factor for hyponatremia and overhydration.A case-control study of patients with a diagnosis of anxiety who received a selective serotonin reuptake inhibitor (SSRI). Serum sodium, urea to creatinine ratio, and odds ratio (OR) of hyponatremia and overhydration before initiation of treatment were compared to those of a control group of participants. Laboratory tests were also examined for changes following treatment with an SSRI. All blood tests were conducted from January 1, 2001 until December 31, 2017. Subjects were selected from a large electronic database, insuring 2 million Israelis. A total of 7211 patients with a diagnosis of anxiety who have received a prescription for an SSRI were identified; 3634 were excluded mostly due to other conditions that could cause hyponatremia, and 3520 participants were included in the case group. The control group consisted of 6985 age and gender matched participants who did not have a diagnosis of anxiety or any other exclusion criteria.Mean serum sodium levels were elevated in cases before the initiation of SSRIs; sodium: case 139.3 (137.3-141.3), control 139.2 (137.06-141.26) mmol/L (P?=?.01). The OR of hyponatremia was 0.89 for the case group (P?=?.004). Treatment with SSRIs decreased mean serum sodium (139.3-139.1?mmol/L; P?=?.0001) and increased by 50% the rate of hyponatremia (2.6-3.9% P?=?.024).It is the use of SSRIs and not anxiety itself that causes hyponatremia among anxious patients.

SUBMITTER: Gilboa M

PROVIDER: S-EPMC6380733 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Anxiolytic treatment but not anxiety itself causes hyponatremia among anxious patients.

Gilboa Mayan M Koren Gideon G Katz Racheli R Melzer-Cohen Cheli C Shalev Varda V Grossman Ehud E

Medicine 20190201 5

The aim of the study was to define whether anxiety itself or only the treatment with anxiolytic medication is risk factor for hyponatremia and overhydration.A case-control study of patients with a diagnosis of anxiety who received a selective serotonin reuptake inhibitor (SSRI). Serum sodium, urea to creatinine ratio, and odds ratio (OR) of hyponatremia and overhydration before initiation of treatment were compared to those of a control group of participants. Laboratory tests were also examined ...[more]

PMID: 30702618

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Project description:Background and objectivesCurrent therapies for hyponatremia have variable effectiveness and tolerability, and in certain instances, they are very expensive. We examined the effectiveness, safety, and tolerability of urea for the treatment of inpatient hyponatremia.Design, setting, participants, & measurementsWe identified all patients hospitalized at the University of Pittsburgh Medical Center between July 2016 and August 2017 with hyponatremia (plasma sodium <135 mEq/L) who received urea, including a subgroup of patients who received urea as the sole drug therapy for hyponatremia (urea-only treated). We matched urea only-treated patients to a group of patients with hyponatremia who did not receive urea (urea untreated) and compared changes in plasma sodium at 24 hours and the end of therapy as well as the proportion of patients who achieved plasma sodium ?135 mEq/L. We abstracted data on adverse events and reported side effects of urea.ResultsFifty-eight patients received urea (7.5-90 g/d) over a median of 4.5 (interquartile range, 3-8) days and showed an increase in plasma sodium from 124 mEq/L (interquartile range, 122-126) to 131 mEq/L (interquartile range, 127-134; P<0.001). Among 12 urea only-treated patients, plasma sodium increased from 125 mEq/L (interquartile range, 122-127) to 131 mEq/L (interquartile range, 129-136; P=0.001) by the end of urea therapy. There was a larger increase in plasma sodium at 24 hours in urea only-treated patients compared with urea-untreated patients (2.5 mEq/L; interquartile range, 0-4.5 versus -0.5 mEq/L; interquartile range, -2.5 to 1.5; P=0.04), with no difference in change in plasma sodium by the end of therapy (6 mEq/L; interquartile range, 3.5-10 versus 5.5 mEq/L; interquartile range, 3-7.5; P=0.51). A greater proportion of urea only-treated patients achieved normonatremia, but this difference was not statistically significant (33% versus 8%; P=0.08). No patients experienced overly rapid correction of plasma sodium, and no serious adverse events were reported.ConclusionsUrea seems effective and safe for the treatment of inpatient hyponatremia, and it is well tolerated.

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Anxiolytic treatment but not anxiety itself causes hyponatremia among anxious patients.

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Anxiolytic treatment but not anxiety itself causes hyponatremia among anxious patients.

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