Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Hyponatremia And Hypokalemia
Question: I had a syndrome of inappropriate antidiuretic hormone reaction during a colonoscopy preparation requiring an emergency room visit that night. I developed hyponatremia and hypokalemia during administration of Go-lytely Prep, requiring intravenous treatment with 1 liter of 0.9% Saline Solution. Currently it has been advised that I need to take the preparation under surveillance as inpatient. What surveillance protocols will be implemented and what type of a preparation will be administered?
Will the preparation be different and will there any contraindications for me with this problem of having the colonoscopy? I have moderately well-controlled hypertension for approximately 26 years. I am on Benicar 40/25 (ARB), Amolodipine (Calcium Channel Blocker) and Acebutolol (Beta Blocker) for treatment.
Will the preparation be different and will there any contraindications for me with this problem of having the colonoscopy? I have moderately well-controlled hypertension for approximately 26 years. I am on Benicar 40/25 (ARB), Amolodipine (Calcium Channel Blocker) and Acebutolol (Beta Blocker) for treatment.
Brief Answer:
Water pill
Detailed Answer:
I see you are on Benicar 40/25. That suggests to me it is very likely to be Benicar HCT as there are 2 medications strengths mentioned (40/25) implying that the Benicar is 40 mg and the other one is HCTZ 25 mg. Please check the actual pill bottle and confirm this.
The reason I am deliberating on this is that diuretics ('water pills') like HCTZ have the potential to lower the blood sodium levels. You may not have SIADH, but likely only diuretic induced hyponatremia, that was precipitated by further electrolyte loss during colonoscopy preparation.
When I see someone like you in my practice, I stop the Benicar H and start Benicar alone. It is perfectly ok to suddenly stop the HCTZ tablet. Of course, blood pressure (BP) monitoring is required and a substitute medication is often necessary, so I increase the dose of Amlodepine or Acebutalol with careful BP and pulse monitoring, or add other classes of BP medications.
I then check the blood sodium levels in 5 to 7 days to confirm my impression.
If the sodium is still low then I initiate a systematic work up for SIADH. It is a challenging diagnosis to make and includes various tests such as
Serum Osmolality
(concurrent) Urine Osmolality, sodium and potassium
Serum Uric acid
BUN
CBC
CMP
TSH
Free T4 8 am serum cortisol
Water pill
Detailed Answer:
I see you are on Benicar 40/25. That suggests to me it is very likely to be Benicar HCT as there are 2 medications strengths mentioned (40/25) implying that the Benicar is 40 mg and the other one is HCTZ 25 mg. Please check the actual pill bottle and confirm this.
The reason I am deliberating on this is that diuretics ('water pills') like HCTZ have the potential to lower the blood sodium levels. You may not have SIADH, but likely only diuretic induced hyponatremia, that was precipitated by further electrolyte loss during colonoscopy preparation.
When I see someone like you in my practice, I stop the Benicar H and start Benicar alone. It is perfectly ok to suddenly stop the HCTZ tablet. Of course, blood pressure (BP) monitoring is required and a substitute medication is often necessary, so I increase the dose of Amlodepine or Acebutalol with careful BP and pulse monitoring, or add other classes of BP medications.
I then check the blood sodium levels in 5 to 7 days to confirm my impression.
If the sodium is still low then I initiate a systematic work up for SIADH. It is a challenging diagnosis to make and includes various tests such as
Serum Osmolality
(concurrent) Urine Osmolality, sodium and potassium
Serum Uric acid
BUN
CBC
CMP
TSH
Free T4 8 am serum cortisol
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have been on Benicar 40mg/HCTZ 25 mg for years and have never experience any form of hyponatremia or hypokalemia until I took than Polyethylene Glycol Prep.
After the electrolyte abnormality was corrected by a 1 liter volume of normal saline which was infused in an emergency room, in addition to two separate doses of Klor-Con 40 meq, my serum sodium and potassium levels had return to by baseline which is respectively 139meq/l and 3.8 meq/l My sodium and potassium that evening had dropped over a two hours period, during the colonoscopy prep administration, to 129meq/l and 2.9 meq/l, respectively. in the emergency room my initial blood pressure was 170/100 mm Hg which I had taken when I developed symptoms of slight confusion and a headache while taking the prep. My blood pressure earlier that day was 122/78 while on medication. I had spaced my medication by 2 hours so their would not be any malabsorption due to the effects of the prep. I have not had any problems since that evening and so I am concern with repeating the prep. Would you have any recommendations besides eliminating the HCTZ. my hypertension is quite labile, I do not want to fool around with that problem.
After the electrolyte abnormality was corrected by a 1 liter volume of normal saline which was infused in an emergency room, in addition to two separate doses of Klor-Con 40 meq, my serum sodium and potassium levels had return to by baseline which is respectively 139meq/l and 3.8 meq/l My sodium and potassium that evening had dropped over a two hours period, during the colonoscopy prep administration, to 129meq/l and 2.9 meq/l, respectively. in the emergency room my initial blood pressure was 170/100 mm Hg which I had taken when I developed symptoms of slight confusion and a headache while taking the prep. My blood pressure earlier that day was 122/78 while on medication. I had spaced my medication by 2 hours so their would not be any malabsorption due to the effects of the prep. I have not had any problems since that evening and so I am concern with repeating the prep. Would you have any recommendations besides eliminating the HCTZ. my hypertension is quite labile, I do not want to fool around with that problem.
Brief Answer:
Follow up
Detailed Answer:
I understand what you are saying but any endocrinologist worth his/her salt will likely approach your condition similarly.
Furthermore, the above blood tests are important because an untreated under active thyroid , and adrenal insufficiency can both cause a low sodium. These are also relevant to be ruled out before a diagnosis of SIADH is made.
Follow up
Detailed Answer:
I understand what you are saying but any endocrinologist worth his/her salt will likely approach your condition similarly.
Furthermore, the above blood tests are important because an untreated under active thyroid , and adrenal insufficiency can both cause a low sodium. These are also relevant to be ruled out before a diagnosis of SIADH is made.
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
