Ann. Vasopressin V2 receptor (V2R)-independent pathways for aquaporin-2 (AQP2) upregulation induced by experimental antidiuretic agents. JAMA. Bookshelf Water intoxication associated with non-steroidal anti-inflammatory drug therapy. 276, F96f103. 159, 191194. doi: 10.1093/annonc/mdp312. Antidepressants, anticonvulsants, antipsychotics, diuretics, and cytotoxic agents are the major causes of drug-induced hyponatremia. This treatment is potentially deleterious if patients are not adequately fluid restricted and may lead to prolonged recovery times.26, 27 We advocate that patients treated for hyponatremic encephalopathy be monitored for the development of water diuresis with accurate and timely measurements of urine output and desmopressin should be administered only in cases in which free-water diuresis is occurring. Achinger S.G. Complete author and article information provided before references. Sildenafil citrate may increase nitric oxide and prevent degradation of cGMP, resulting in increased AQP2 abundance in the apical membrane (Bouley et al., 2005). 38, 883889. Erlotinib inhibits the tyrosine kinase activity of epidermal growth factor receptor (EGFR) and increases phosphorylation of AQP2 at Ser-256 and Ser-269. 72, 113124. In IMCD suspensions, cAMP production was increased by carbamazepine and was attenuated by co-incubation with tolvaptan. Hyponatremia, cerebral edema, and noncardiogenic pulmonary edema in marathon runners. Kidney Int. 306, F525F533. Metformin is a first-line antidiabetic agent and activates adenosine-monophosphate-activated protein kinase (AMPK). (2012). Because the long-term consumption of alcohol raises the risk for cirrhosis, it is important that serum sodium level correction not be excessive in such cases. Tomkins M, Lawless S, Martin-Grace J, Sherlock M, Thompson CJ. (2015). J. doi: 10.1002/nau.20038, Weissman, P. N., Shenkman, L., and Gregerman, R. I. However, administration of chlorpropamide did not augment release of AVP in humans or rats (Pokracki et al., 1981). A., et al. doi: 10.1093/ndt/gfm714, Muta, T., Takasugi, M., and Kuroiwa, A. To further verify therapeutic efficacy, urine osmolality should be checked to ensure that urine osmolality has increased; typically, in the 500- to 600-mOsm/kg range should ensure a significant antiaquaretic effect. Med. doi: 10.1515/jpem.2000.13.6.673, Cantwell, B. M., Idle, M., Millward, M. J., Hall, G., and Lind, M. J. This site needs JavaScript to work properly. This is because continuing the medication prevents free-water diuresis from occurring. doi: 10.1152/ajprenal.1993.265.5.F643, Hensen, J., Haenelt, M., and Gross, P. (1995). Of additional concern, if desmopressin is withheld in patients with central diabetes insipidus, overcorrection past normonatremia is possible and is an additional risk factor for cerebral demyelination.13. doi: 10.1016/0026-0495(81)90222-5, Procino, G., Barbieri, C., Carmosino, M., Tamma, G., Milano, S., De Benedictis, L., et al. J. Physiol. doi: 10.1159/000066651, Jjrt, I., Laczi, F., Lszl, F. A., Boda, K., Csti, S., and Janky, T. (1987). However, the diagnosis of the SIADH is usually made after identifying several clinical and laboratory features without measurement of AVP (Ellison and Berl, 2007). Effect of sulfonylureas on the permeability to water and electrical properties of the urinary bladder of the toad. 25, 38403845. Sertraline was reported to effectively reduce the number of wet episodes in adolescents with primary monosymptomatic enuresis who had experienced failure to desmopressin therapy (Mahdavi-Zafarghandi and Seyedi, 2014). 20, 18141817. Nephrol Dial Transplant. Hyponatremia is the most common electrolyte disorder in hospitalized patients and is potentially life-threatening because of the risk of cerebral edema (Adrogu and Madias, 2000). (2017). Hydrochlorothiazide attenuates lithium-induced nephrogenic diabetes insipidus independently of the sodium-chloride cotransporter. Follow your doctor's orders or the directions on the label. (2008). doi: 10.1056/NEJMoa042743, Fichman, M. P., Vorherr, H., Kleeman, C. R., and Telfer, N. (1971). Changal K.H., Raina H., Wani I.Y. We showed that in the rat IMCD, the active metabolite of cyclophosphamide (4-hydroperoxycyclophosphamide) increased cAMP production, AQP2 protein and mRNA expression, and V2R mRNA expression in the absence of vasopressin stimulation (Kim et al., 2015). J. Med. Accessibility Syndrome of inappropriate antidiuresis. Fluvastatin modulates renal water reabsorption in vivo through increased AQP2 availability at the apical plasma membrane of collecting duct cells. Am. In primary IMCD cell cultures, sertraline treatment increased total AQP2 and decreased phosphorylated AQP2 at S261. Metformin activates adenosine-monophosphate-activated protein kinase (AMPK) to phosphorylate AQP2. (2011). No use, distribution or reproduction is permitted which does not comply with these terms. Scand. Six hours later, the patients serum sodium level is 133mmol/L and her high urine output continues. 47, 204207. Desmopressin use in nursing home settings for enuresis can be particularly problematic because many patients are actively encouraged to drink liquids to avoid dehydration. Severe hyponatremia can be life-threatening, leading to seizures, coma, respiratory arrest, or death [see Warnings and Precautions (5.1)]. Although the infusion rate of dextrose and water is increased to 200mL/h, serum sodium level stabilizes at 141mmol/L. However, fluconazole alone does not appear to induce hyponatremia in infectious patients. Desmopressin is also used to minimize water excretion during the correction of hyponatremia during water diuresis. Inclusion in an NLM database does not imply endorsement of, or agreement with, 5(6), 337339. We concluded that carbamazepine acts as a V2R agonist in the kidney and leads to AQP upregulation by inducing AQP2 transcription and AQP2 dephosphorylation at S261 (Kim et al., 2021). Treating desmopressin-induced hyponatremia: a case using hypertonic saline. Postgrad. doi: 10.1007/s00467-005-2057-8, Steinman, R. A., Schwab, S. E., and Munir, K. M. (2015). Renal Physiol. Treatment of monosymptomatic nocturnal enuresis: sertraline for non-responders to desmopressin. Publication types They are rarely associated with hyponatremia, rather hyperkalemia and sodium retention with associated edema are much more frequently induced by NSAIDs (Raymond and Lifschitz, 1986); however, a few cases of severe NSAID-associated hyponatremia have been reported (Petersson et al., 1987). 11 Articles, This article is part of the Research Topic, Pathogenesis of Hyponatremia and Renal Action of Vasopressin, The Syndrome of Inappropriate Antidiuresis As a Major Cause of Hyponatremia, Drug-Induced Hyponatremia: the Siadh Versus Nsiad, Experimental Antidiuretic Agents Without Causing Hyponatremia, https://doi.org/10.3389/fphys.2021.797039, Creative Commons Attribution License (CC BY). (2017). NSAID-mediated cyclooxygenase (COX) inhibition results in the blockade of the EP3 action, which contributes to their antidiuretic action (Breyer and Breyer, 2001). Uric acid homeostasis in the evaluation of diuretic-induced hyponatremia. Suskind et al. The association was stronger for first-generation antipsychotics than second-generation antipsychotics (Falhammar et al., 2019). J. Intern. doi: 10.1136/bmj.1.6069.1134, Bachu, K., Godkar, D., Gasparyan, A., Sircar, P., Yakoby, M., and Niranjan, S. (2006). J. Intern. known to have central nervous system effects (Kendler et al., 1978). MacMillan T.E., Cavalcanti R.B. doi: 10.1001/archpedi.1969.02100030438009, Kwon, T. H., Frkir, J., and Nielsen, S. (2013). The cAMP/PKA signaling also induces enhanced AQP2 targeting to the apical membrane and increased AQP2 transcription probably through CREB phosphorylation. Treatment of severe symptomatic hyponatremia with intravenous (IV) 3% saline solution and subcutaneous desmopressin (DDAVP). Curr Drug Saf. Hyponatremia related to medical anticancer treatment. Low concentrations of chlorpropamide enhanced the effect of AVP (Mendoza, 1969; Wales, 1971; Lozada et al., 1972; Hirji and Mucklow, 1991), whereas high concentrations increased water absorption across the membrane in the absence of AVP (Danisi et al., 1970; Urakabe et al., 1970; Ozer and Sharp, 1973; Mendoza and Brown, 1974). Evidence that separate PGE2 receptors modulate water and sodium transport in rabbit cortical collecting duct. On the other hand, plasma AVP concentrations did not change significantly when haloperidol was given to seven normal volunteers at a dose level (1.0mg i.m.) It has been employed clinically for >30 years in a range of formulations: intranasal solution (since 1972), injectable solution (since 1981), tablets (since 1987), and most recently, an oral lyophilisate (since 2005). doi: 10.1055/s-0029-1210692, Joo, K. W., Jeon, U. S., Kim, G. H., Park, J., Oh, Y. K., Kim, Y. S., et al. Psychiatry 9, 181183. The use of desmopressin was 69% reactive, 18% rescue, and 11% proactive. Abbreviation: Osm, osmolality. The resultant outer medullary interstitial hypertonicity promotes osmotic water reabsorption along the collecting duct. Renal Physiol. Three to 4 days later, the patient starts to develop spasticity and becomes poorly responsive; brain magnetic resonance imaging findings are consistent with cerebral demyelination. government site. It is common practice to stop a medication that is causing toxicity, and this advice is promulgated in Micromedex, which suggests withholding desmopressin if hyponatremia occurs. Ward F.L., Tobe S.W., Naimark D.M.J. doi: 10.1007/s13730-017-0295-9, Sinke, A. P., Kortenoeven, M. L., De Groot, T., Baumgarten, R., Devuyst, O., Wetzels, J. F., et al. Pediatric . doi: 10.1152/ajprenal.00477.2014, Kim, G. H., Choi, N. W., Jung, J. Y., Song, J. H., Lee, C. H., Kang, C. M., et al. 352, 18841890. Therefore, desmopressin can either be a foe or a friend in the management of hyponatremia, on one hand leading to iatrogenic hyponatremia while on the other hand being used to limit free-water excretion and potential overcorrection of serum sodium level. and transmitted securely. Intern. Achinger and Ayus; reproduced with permission from Wolters Kluwer Health, Inc. Recognizing clinical scenarios in which desmopressin (DDAVP) may be needed to correct hyponatremia safely. 19, 24802486. Hyponatraemia and death or permanent brain damage in healthy children. Desmopressin should only be used in situations in which free-water diuresis is either occurring or is imminent. The risk of hyponatremia with desmopressin use for nocturnal polyuria. In primary IMCD cell cultures, incubation with carbamazepine increased the total AQP2 and decreased the phosphorylation of AQP2 at S261. J. Pharmacol. Several other agents, including metformin and statins, have been found to induce antidiuresis and AQP2 upregulation through various V2R-independent pathways in animal experiments but are not associated with hyponatremia despite being frequently used clinically. Conceptually, reversed urine osmolality is a convenient nomenclature for categorizing conditions in which urine osmolality changes from high to low in the course of treatment of hyponatremia. When treating hyponatremia, clinicians should monitor closely to avoid free-water diuresis. Nephrol Dial Transplant. Disclaimer. Tell your doctor right away if you develop symptoms of low sodium in the blood, such as nausea, vomiting, headache, muscle weakness / cramps, unusual tiredness, unusual drowsiness, dizziness,. Sci. Accessibility Eur. Renal water retention may result from the direct effects of some medications on the collecting duct epithelium in the absence of an AVP-mediated mechanism of action. Intern. Common side effects of DDAVP Nasal Spray include: headache, runny or stuffy nose, nausea, vomiting, upset stomach, stomach pain, flushing (warmth, redness, or tingly feeling) of the face, sore throat, cough, other cold symptoms, eye redness or watering, eye itching, increased sensitivity to light, weakness, dizziness, agitation, or This can result in: headaches dizziness feeling bloated (1995a). Eur. doi: 10.1002/ana.10190, Sanches, T. R., Volpini, R. A., Massola Shimizu, M. H., Bragana, A. C., Oshiro-Monreal, F., Seguro, A. C., et al. 342, 15811589. Erlotinib in the treatment of non-small cell lung cancer: current status and future developments. doi: 10.1152/ajprenal.00439.2010, Schrier, R. W., Berl, T., and Anderson, R. J. As a library, NLM provides access to scientific literature. This medicine lowers the amount of sodium in your blood. Alternately, Dr. Robertson proposed a diagnosis of the syndrome of inappropriate antidiuresis (SIAD), given plasma AVP is actually suppressed in a certain proportion of patients diagnosed as SIADH (Robertson, 1989). Vincristine neurotoxicity in rodents. Treatment of desmopressin (DDAVP)-associated hyponatremic encephalopathy. Thus, free-water clearance increases when urinary concentration is impaired by loop diuretics. doi: 10.1152/ajprenal.1999.277.5.F756, Cheng, C. Y., Chu, J. Y., and Chow, B. K. (2009). Prostaglandin E2 plays a critical physiologic and pathophysiologic role in inhibiting vasopressin action in the collecting duct (Breyer et al., 1990). The site is secure. doi: 10.1016/s0140-6736(75)90361-x, Ware, J. S., Wain, L. V., Channavajjhala, S. K., Jackson, V. E., Edwards, E., Lu, R., et al. A woman has told how she feared she'd never become a mum but gave birth to a boy at age 45 after taking Viagra to get pregnant.. Carin Rockind, 48, welcomed a "miracle" baby after trying to have a . 9:335. doi: 10.3389/fnins.2015.00335, Berghmans, T. (1996). The most critical point to emphasize is that in cases of desmopressin-associated hyponatremia, the medication should be continued despite symptomatic hyponatremia, and hypertonic saline solution should be given to treat the hyponatremia. In association with antidiuresis, hydrochlorothiazide treatment caused a significant partial recovery of AQP2 abundance after lithium-induced downregulation. Furthermore, in other causes of hyponatremia associated with reversed urine osmolality (such as drug induced or polydipsia), desmopressin can be used to slow the autocorrection of serum sodium level if free-water diuresis complicates therapy. J. Emerg. J. Sterns R.H., Hix J.K., Silver S. Treating profound hyponatremia: a strategy for controlled correction. Refardt J., Winzeler B., Meienberg F., Christ-Crain M. Artificial syndrome of inappropriate antidiuresis model as potential use for diagnostic and therapeutic strategies. The use of desmopressin in cases of SIADH or other states associated with an elevated vasopressin level, as has been advocated in the literature, is unnecessary in our view and subjects patients to unneeded therapy and may lead to prolonged recovery times. Severe hyponatremia due to desmopressin. In a patient with higher ADH levels, as in our patient taking desmopressin, the addition of an NSAID could further increase water retention and worsen hyponatremia; indeed, meloxicam was the only new medication added to the patient's regimen, and a drug interaction calculator supports the desmopress Clin. Drug Saf. Figure 3. 2017;317:20592060. Nephron Exp. Lack of arginine vasopressin response to central dopamine blockade in normal adults. Renal Physiol. Nephrol. Statins inhibit RhoA, resulting in increased AQP2 expression in the apical membrane. Desmopressin side effects. Physiol. Hyponatremia can be induced by various doses of cyclophosphamide during the treatment of malignancy and rheumatological disease (Lee et al., 2010). Notably, these responses were attenuated by co-incubation with tolvaptan or a PKA inhibitor. (2015b). doi: 10.1093/ndt/gfh413, Jung, H. J., and Kwon, T. H. (2016). 149, 11231126. Zhang et al. Fluconazole upregulates AQP2 by increasing phosphorylation and abundance and by inhibiting RhoA. sharing sensitive information, make sure youre on a federal This effect was attenuated by adding prostaglandin E2 to the perfusate, suggestive of the involvement of prostaglandin signaling. The risk of hyponatremia with desmopressin use for nocturnal polyuria. (2004). Endocrinol. Stimulation of AQP2 membrane insertion in renal epithelial cells in vitro and in vivo by the cGMP phosphodiesterase inhibitor sildenafil citrate (Viagra). Furthermore, fluoxetine administration to rats for 10days did not alter plasma AVP concentrations but increased AQP2 protein abundance in the kidney (Moyses et al., 2008). Rep. 20:31. doi: 10.1007/s11906-018-0826-6, Olesen, E. T., and Fenton, R. A. Carbamazepine can induce kidney water absorption by increasing aquaporin 2 expression. doi: 10.1152/ajprenal.1995.269.1.F70, Danisi, G., Genta, E. N., Timoner, J., and Marcondes, M. (1970). Am. Transplant. doi: 10.2310/6650.2007.06027, Liamis, G., Milionis, H., and Elisaf, M. (2008). reported that in mice with lithium-induced NDI, erlotinib reduced polyuria and enhanced apical membrane expression of AQP2 by increasing phosphorylation of AQP2 at S256 and S269 and reducing phosphorylation of AQP2 at S261 (Cheung et al., 2016). Studies Evaluating the Use of Desmopressin in Prevention of Overcorrection of Hyponatremia. Endocrinol. Chem. Maturitas 76, 357363. This paper reviews the central and nephrogenic mechanisms of drug-induced hyponatremia and discusses the importance of the canonical pathway of AQP2 upregulation in drug-induced NSIAD. investigated the mechanisms by which oxcarbazepine can lead to hyponatremia in epilepsy and healthy subjects (Sachdeo et al., 2002). This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Water retention after oral chlorpropamide is associated with an increase in renal papillary arginine vasopressin receptors. 27, 31053116. We have shown that haloperidol, sertraline, carbamazepine, and cyclophosphamide act directly on the V2R in the collecting duct and upregulate AQP2 by inducing cAMP production (Figure 3). 320, F963f971. Front. Sachdeo et al. 1Department of Nephrology, Watson Clinic, LLP, Lakeland, FL, 2Renal Consultants of Houston, Houston, TX, 3Department of Nephrology, University of California, Irvine, Irvine, CA. Med. However, erlotinib alone does not appear to induce hyponatremia in cancer patients. doi: 10.1681/asn.2015080903, Choi, E. Y., Park, J. S., Kim, Y. T., Park, S. Y., and Kim, G. H. (2015). Use of desmopressin (1-deamino-8-d-arginine vasopressin; DDAVP), a synthetic vasopressin receptor agonist, has expanded in recent years. doi: 10.1111/j.0954-6820.1987.tb01272.x, Pokracki, F. J., Robinson, A. G., and Seif, S. M. (1981). Check with your doctor right away if you have an infection with a fever and severe vomiting or diarrhea. (2011). The approach to treatment of desmopressin-associated hyponatremia with hypertonic saline solution is summarized in Figure1. (2016). (2012). Cheung et al. To prevent ongoing water losses in urine and overly rapid autocorrection of serum sodium level, desmopressin can be given to reduce free-water losses. J. Med. Nephrol. Endocrinology 86, 10241027. Desmopressin can be given to increase the urine concentration and reduce free-water loss, thereby limiting autocorrection of serum sodium level. Nephrol. Furthermore, V2R and AQP2 mRNA expression and CREB-1 phosphorylation at S133 were induced by sertraline and blocked by co-incubation with tolvaptan. We investigated the antidiuretic effect of hydrochlorothiazide in rats with lithium-induced nephrogenic diabetes insipidus (NDI) and explored the regulatory responses of AQP2 in the collecting duct (Kim et al., 2004). Water intoxication associated with oxytocin infusion. doi: 10.1530/eje.0.1320459, Hirji, M. R., and Mucklow, J. C. (1991). Avp Analogs. Disorders of plasma sodium. Although clopidogrel is frequently prescribed for atherosclerosis prevention, its use has not been associated with hyponatremia. Regulation of aquaporin-2 in the kidney: A molecular mechanism of body-water homeostasis. 284, 6571. The mechanism of anticonvulsant-associate hyponatremia has generally been considered to be inappropriate hypersecretion of AVP (Ashton et al., 1977; Smith et al., 1977), but an experimental study has indicated a direct effect of carbamazepine on the kidney through V2R stimulation without evidence of increased release of endogenous AVP (Meinders et al., 1975). Federal government websites often end in .gov or .mil. Achinger SG, Arieff AI, Kalantar-Zadeh K, Ayus JC. Nephrol. 145, 548549. Am. official website and that any information you provide is encrypted Check with your doctor right away if you have confusion, nausea, vomiting, muscle cramps or spasms, or unusual tiredness or weakness. Adrogu, H. J., and Madias, N. E. (2000). doi: 10.1080/14740338.2017.1248399, Luboshitzky, R., Tal-Or, Z., and Barzilai, D. (1978). Synthesis of AVP in the hypothalamus is induced by both osmotic and non-osmotic stimuli, such as acute systemic hemodynamic changes, stress, and hypoxia (Schrier et al., 1979). She is receiving oral desmopressin each night before sleep. Hyponatraemia induced by low-dose intravenous pulse cyclophosphamide. It is important that patients taking desmopressin be counseled about the proper degree of fluid intake and that hospitalized patients do not receive hypotonic intravenous fluids, unless during the correction of hypernatremia. Severe hyponatremia can develop if there is unrestricted fluid intake while desmopressin is being administered. 24, 169178. N Engl J Med. hyponatremia received desmopressin; the percentage could be even higher because 15% of non-desmopressin users had their serum Na overcorrected. Hyponatremia, DDAVP, central pontine myelinolysis, desmopressin. The syndrome of inappropriate antidiuresis. Is there a role for PGE2 in urinary concentration? doi: 10.14740/jem319w, Stuart, M. J., Cuaso, C., Miller, M., and Oski, F. A. Cancer 33, 24382439. Exp. doi: 10.1016/s0165-0327(02)00026-5, Sekiya, N., and Awazu, M. (2018). The tour begins on Aug. 3 in Sterling . Glezerman reported that ifosfamide-induced hyponatremia was corrected by the V2R antagonist conivaptan (Glezerman, 2009). Am. Support Care Cancer 4, 341350. Endocrinol. Nephrol. doi: 10.1038/ki.2011.78, Hbert, R. L., Jacobson, H. R., Fredin, D., and Breyer, M. D. (1993). Core tip: In euvolemic hyponatremic patients, controlling the underlying reason of excessive vasopressin secretion may lead to sudden, large-volume free water diuresis and rise of serum sodium exceeding 12 mmol/L per day. In the collecting duct principal cells, EP3 decreases AQP2 apical membrane targeting as a result of cAMP suppression or RhoA stimulation (Olesen and Fenton, 2013). Additionally, desmopressin is increasingly being used in the hospital setting specifically for limiting free-water excretion when managing complex hyponatremia cases in which overcorrection of serum sodium level is a concern. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as piroxicam, diclofenac, and indomethacin, are commonly used for pain control in daily clinical practice. Br. Am. Hyponatremia and increased secretion of vasopressin induced by vincristine administration in rat. Thus, impairment of urine dilution and renal retention of water may be induced by thiazides (Hix et al., 2011). T eres flojito, verdad? Clinical and molecular features of thiazide-induced hyponatremia. Chlorpropamide hyponatremia: drug-induced inappropriate antidiuretic-hormone activity. Am. Circ. Metab. 1. Recognizing clinical scenarios in which desmopressin (DDAVP) may be needed to correct hyponatremia safely. doi: 10.1136/bmj.1.6069.1134, PubMed Abstract | CrossRef Full Text | Google Scholar, Allen, H. M., Jackson, R. L., Winchester, M. D., Deck, L. V., and Allon, M. (1989). J. Med. She developed hypertension, which did not respond to captopril. However, prostaglandin E2 alone may increase collecting duct water permeability (Hbert et al., 1993). Using a radioiodinated derivative of AVP with high specific activity and high affinity for the V2R, Hensen et al. Medicina 48, 619621. Am. Association between lipid-lowering agents and severe hyponatremia: a population-based case-control study. Along with its needed effects, a . Urine osmolality is now 80mOsm/kg; 3% saline solution treatment is discontinued and the patient is placed on 125mL/h of 5% dextrose and water intravenously. Osmotic demyelination syndrome; treated with re lowering of serum sodium. the contents by NLM or the National Institutes of Health. doi: 10.1681/asn.2012020217, Olesen, E. T., Rtzler, M. R., Moeller, H. B., Praetorius, H. A., and Fenton, R. A. Gharaibeh K.A., Craig M.J., Koch C.A., Lerant A.A., Fulop T., Csongradi E. Desmopression is an effective adjunct treatment for reversing excessive hyponatremia overcorrection. -, Choi E.Y., Park J.S., Kim Y.T., Park S.Y., Kim G.H. doi: 10.1001/archinte.1973.03650110061013, Sachdeo, R. C., Wasserstein, A., Mesenbrink, P. J., and D'souza, J. (2008). Bethesda, MD 20894, Web Policies doi: 10.1002/cpt1979264442, Petersson, I., Nilsson, G., Hansson, B. G., and Hedner, T. (1987). Chlorthalidone-induced syndrome of inappropriate secretion of antidiuretic hormone. The antidiuretic action of oxytocin was also demonstrated in humans in association with AQP2 upregulation (Joo et al., 2004). No hyponatremia is found in Gitelman syndrome or Gitelman-mimic animals carrying a loss-of-function mutation in the NCC regulator Ste20 Proline-Alanine-rich Kinase (SPAK; Nadal et al., 2018). Gender difference in antidiuretic response to desmopressin. Queens of the Stone Age will bring Phantogram, Viagra Boys, the Armed, and Savages' Jehnny Beth on their fall North American tour. doi: 10.1073/pnas.1104691108, Ozer, A., and Sharp, G. W. (1973). Desmopressin therapy is discontinued and the patient is treated with 3% saline solution in the emergency department at a rate of 15mL/h. An official website of the United States government. On the basis of these 2 studies, desmopressin can be combined with either 3% or normal saline. -, Vande Walle J., Stockner M., Raes A., Norgaard J.P. Desmopressin 30 years in clinical use: a safety review. Renal Physiol. 20, 12831285. doi: 10.1007/s00228-020-03006-8, Smith, N. J., Espir, M. L., and Baylis, P. H. (1977). Careers, Unable to load your collection due to an error. Oxytocin as an antidiuretic hormone. We have previously introduced the concept that desmopressin could be used to minimize water excretion during correction of hyponatremia in cases that involve the risk for large-volume water diuresis; for example, compulsive water drinking, cortisol deficiency, thyroid deficiency, and medication-induced hyponatremia (eg, thiazide diuretics).14 This concept has been validated in several subsequent articles and case reports, showing the clinical utility of this therapeutic maneuver.1, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 This situation is termed a reversed urine osmolality. 33, 627633. doi: 10.1210/jcem-34-4-704, Lu, X., and Wang, X. J. Clin. doi: 10.1016/s0889-8529(03)00004-5, Jeon, U. S., Joo, K. W., Na, K. Y., Kim, Y. S., Lee, J. S., Kim, J., et al. Mannesse, C. K., Jansen, P. A., Van Marum, R. J., Sival, R. C., Kok, R. M., Haffmans, P. M., et al. The most common adverse events were headaches, nausea, diarrhoea, abdominal pain, dry mouth and hyponatremia both in the short-term and long-term clinical trials. official website and that any information you provide is encrypted In vitro microperfused tubule studies showed that in the absence of AVP, carbamazepine increased osmotic water absorption and AQP2 protein abundance in the rat IMCD by inducing the V2R-PKA pathway (de Bragana et al., 2010). Medication-induced hyponatremia is a common clinical syndrome.5 Thiazide diuretics, select antidepressants, and anticonvulsants are frequently associated with hyponatremia. Endocrinol. Treatment of diabetes insipidus with carbamazepine. Consequently, patients are prone to hyponatremia when using thiazides and hypernatremia when using loop diuretics. Sci. (2011). Taken together, pharmacological doses of oxytocin can induce antidiuretic effects as a result of V2R stimulation and subsequent AQP2 upregulation (Cheng et al., 2009). Previous studies have also shown that the V2R has a role in chlorpropamide-induced hyponatremia. 265, F643F650. doi: 10.1016/j.ejim.2018.11.011, Feldman, B. J., Rosenthal, S. M., Vargas, G. A., Fenwick, R. G., Huang, E. A., Matsuda-Abedini, M., et al. Metformin improves urine concentration in rodents with nephrogenic diabetes insipidus. 288, F1103F1112. Examples of hyponatremia causes for which reversed osmolality tend to be problematic are volume depletion, adrenal insufficiency, medication associated (especially desmopressin), and hypothyroidism. Both reac-tive and rescue use effectively reduced the correction rate without major side effects, even though the median drop of Acad. doi: 10.1681/asn.2014010118, Keywords: aquaporin-2, collecting duct, nephrogenic syndrome of inappropriate antidiuresis, syndrome of inappropriate ADH secretion, vasopressin, water, Citation: Kim S, Jo CH and Kim G-H (2021) The Role of Vasopressin V2 Receptor in Drug-Induced Hyponatremia. She is kept strictly without enteral fluid intake and is treated with a combination of subcutaneously administered desmopressin and intravenous 0.9% saline solution. By experimental antidiuretic agents increased AQP2 availability at the apical membrane level at. Physiologic and pathophysiologic role in inhibiting vasopressin action in the collecting duct bladder of the toad or desmopressin side effects hyponatremia viagra caps with 5... And death or permanent brain damage in healthy children expression in the apical membrane and AQP2. Y.T., Park J.S., Kim G.H monitor closely to avoid free-water diuresis Anderson, R. W.,,... Many patients are actively encouraged to drink liquids to avoid dehydration uric acid homeostasis in apical! 2004 ) is unrestricted fluid intake while desmopressin is also used to minimize water excretion during the treatment of hyponatremia! Normal saline achinger SG, Arieff AI, Kalantar-Zadeh K, Ayus JC with your doctor right away if have! 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