Hyponatremia Due to an Interaction Between Hydromorphone and Desmopressin in a Patient with Central Diabetes Insipidus: A Case Report

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Gillian Mazzetti MD
Oren Steen MD
Ameen Patel MD
Natalia McInnes MD

Hydromorphone, hyponatremia, desmopressin, central diabetes insipidus

Abstract

There are case reports of opiate-induced hyponatremia thought to be mediated by increased secretion of antidiuretic hormone. We report a case of hyponatremia in a woman with central diabetes insipidus treated with desmopressin after receiving large doses of hydromorphone which suggests a different mechanism of opiate action.
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References

1. Adrogue HJ, Madias NE. Hyponatremia. New Engl J Med 2000;342:1581-9.
2. Freda BJ, Nurko S. Hyponatremia and hypernatremia. In: Carey WD, Gordon S, eds. Cleveland Clinic: Current Clinical Medicine. 2nd edition. Philadelphia, PA: Elvesier Saunders; 2010: 818-823.
3. Halperin ML, Goldstein MB. Fluid, electrolyte and acid-base physiology – a problem based approach. 3rd edition. Philadelpha PA: Elvesier Saunders; 1999; 697.
4. Kokko H, Hall PD, Afrin LB. Fentanyl-associated syndrome of inappropriate antidiuretic hormone secretion. Pharmacotherapy 2002;22:1188-92.
5. Udy A, Deacy N, Barnes D, et al. Tramadol-induced hyponatraemia following unicompartmental knee replacement surgery. Anaesthesia 2005;60:814-6.
6. Le Berre JP, Desramé J, Lecoules S, et al. Hyponatremia due to tramadol. Rev Med Interne 2007;28:888-9.
7. Lota AS, Dubrey SW, Wills P. Profound hyponatremia following a tramadol overdose. QJM – Int J Med 2012;105:397-8.
8. Vuong C, Van Uum SH, O’Dell LE, et al. The effects of opiate and opiate analogs on animal and human endocrine systems. Endocr Rev 2010;31:98-132.
9. Liamis G, Milionis H, Elisaf M. A review of drug-induced hyponatremia. Am J Kidney Dis 2008;52:144-53.
10. Masferrer JL, Seibert K, Zweifel B, et al. Endogenous glucocorticoids regulate an inducible cyclooxygenase enzyme. Proc Natl Acad Sci USA 1992;89:3917-21.
11. Garella S, Matarese RA. Renal effects of prostaglandins and clinical adverse effects of nonsteroidal anti-inflammatory agents. Medicine 1984;63:165-81.
12. Rault R. Case report: hyponatremia associated with nonsteroidal antiinflammatory drugs. Am J Med Sci 1993;305:318-20.
13. Gomez García EB, Ruitenberg A, Madretsma GS, et al. Hyponatraemic coma induced by desmopressin and ibuprofen in a woman with von Willebrand’s disease. Haemophilia 2003;9:232-4.
14. Inturrisi CE, Fujimoto JM. Studies on the antidiuretic action of morphine in the rat. Eur J Pharmacol 1968;2:301-7.
15. Huidobro F, Huidobro-Toro J. Antidiuretic effect of morphine and vasopressin in morphine tolerant and non-tolerant rats, differential effects on urine composition. Eur J Pharmacol 1979;59:55-64.
16. Weiskopf RB, Reid IA, Fisher DM, et al. Effects of fentanyl of vasopressin secretion in human subjects. J Pharmacol Exp Ther 1987;242:970-3.
17. Sezen S. Opioid control of renal excretion of water and sodium. J Pharm Sci 2003;28:27–37.
18. Wilson N, Ngsee J. Antidiuretic effect of acute morphine administration in the conscious rat. Can J Physiol Pharmacol 1982;60:201-4.
19. Kapusta DR, Jones SY, DiBona GF. Renal mu opioid receptors mechanisms in regulation of renal function in rats. J Pharmacol Exp Ther 1991;258:111-17.
20. Kapusta DR. Jones SY, Kopp UC et al. Role of renal nerves in excretory responses to exogenous and endogenous opioid peptides. J Pharmacol Exp Ther 1998;248:1037-47.