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Gastroenterology & Hepatology: Open Access

Proceeding Volume 4 Issue 2

Hyponatremic Seizure Associated with Concomitant Use of Standard Dose Trimethoprim-Sulfamethoxazole with a Diuretic

Lynda Hoang, Rabaiya Ali, Jose Manriquez

Internal Medicine Residency, Parkview Medical Center, USA

Correspondence: Lynda Hoang, Internal Medicine Residency, Parkview Medical Center, USA

Received: January 26, 2016 | Published: February 11, 2016

Citation: Hoang L, Ali R, Manriquez J, Sultan S (2016) Hyponatremic Seizure Associated with Concomitant Use of Standard Dose Trimethoprim-Sulfamethoxazole with a Diuretic. Gastroenterol Hepatol Open Access 4(2): 00095. DOI: 10.15406/ghoa.2016.04.00095

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Proceeding

Trimethoprim-Sulfamethoxazole (TMP-SMX) is an antimicrobial agent used to treat infectious disease pathogens.1 Electrolyte abnormalities, primarily hyperkalemia and hyponatremia, are rare adverse effects reported with higher doses of trimethoprim use.2 Paucity of data exists for similar effects in patients using standard doses of TMP- SMX,3 with no previous reported case of trimethoprim induced hyponatremic seizure in the literature. We illustrate a case of severe hyponatremia and hyponatremic seizure in a patient on regular dose of TMP-SMX who was concomitantly using a diuretic.

A 64-year old hypertensive female taking Lisinopril-HCTZ (20-12.5mg) combination pill was started on TMP-SMX (160-800 mg) twice daily for left fourth toe blister. She presented to the emergency room four days later with fatigue, confusion, and a witnessed grandmal seizure. Physical examination, electrocardiogram, urinalysis, chest X-ray, and cranial computed tomography were unremarkable. Serum Na was measured at 119mmol/L (136-145mmol/L) compared to 131mmol/L last week prior to antibiotic use. Other labs included TSH 0.94U/L, glucose 109 mg/dl , K 3.9 (3.5-5.1mmol/L), SOsm 245mOsmL/kg (280- 303mOsm/Kg), BUN 10mg/dL (7-18mg/dl), SCr 0.9mg/dL (0.4-0.9mg/dL), BUN: SCr 11.1 (10.0-20.0) and creatinine clearance 52.2 mL/min using Cockcroft-Gault equation. Urinary indices showed UOsm 205mOsm/kg (50-800 mOsm/kg), UNa 22mmol/L, UCr 24.5mg/dL and FENa 0.7%. TMP-SMX and Lisinopril-HCTZ were discontinued. The patient received hypertonic saline. Serum Na gradually improved to 131mmol/L over 24 hours and the patient’s confusion resolved without further seizures.

Trimethoprim, a heterocyclic weak base, structurally mimics potassium-sparing diuretics, and at higher doses causes natriuresis by blocking sodium reabsorption in the distal nephron.4 Hyponatremia, while usually asymptomatic, can exert neurological sequelae. In our case, standard dose TMP-SMX lead to salt wasting and severe hyponatremia which manifested as seizure; its dose- dependent effect was perhaps potentiated by the concomitant use of a diuretic which can induce renal dysfunction and affect sodium and water hemostasis.

Acknowledgments

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Conflicts of interest

Author declare that there is no conflict of interest.

Funding

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References

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©2016 Hoang, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.