Hyponatremia with sulfonylureas

Mild hyponatremia has been reported with sulfonylureas, most commonly with chlorpropamide (72,73). The mechanism with chlorpropamide is secretion of ADH... 

Loss of blood glucose control When a patient stabilized on any diabetic regimen is exposed to stress such as fever, trauma, infection, or surgery, a loss of control may occur. At such times, it may be necessary to discontinue the drug and give insulin. Disulfiram-like syncframe. A sulfonylurea-induced facial flushing or breathlessness reaction may occur when some sulfonylureas are administered with alcohol. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) Water retention and dilutional hyponatremia have occurred after administration of sulfonylureas to type 2 diabetes patients, especially those with CHF or hepatic cirrhosis. 

Other side effects of sulfonylureas include nausea and vomiting, cholestatic jaundice, agranulocytosis, aplastic and hemolytic anemias, generalized hypersensitivity reactions, and rashes. About 10-15% of patients who receive these drugs, particularly chlorpropamide, develop an alcohol-induced flush similar to that caused by disulfiram see Chapter 23). Sulfonylureas, especially chlorpropamide, may induce hyponatremia by potentiating the effects of vasopressin on the renal collecting duct see Chapter 29), and this effect on water retention has been used to therapeutic advantage in patients with mild forms of central diabetes insipidus. 

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