Abstract
Background: Hyponatremia due to syndrome of inappropriate antidiuresis (SIAD) is a common and challenging electrolyte disorder, particularly in hospitalized and elderly patients. Conventional treatments, such as fluid restriction and vasopressin receptor antagonists, have limitations related to efficacy, tolerance, availability, and cost. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), primarily used for type 2 diabetes, have shown potential in promoting osmotic diuresis and free water clearance, making them a promising therapeutic alternative for SIAD-induced hyponatremia.
Methodology: A retrospective cohort study was conducted at Northwest General Hospital, Peshawar, Pakistan, analyzing medical records of 50 adult patients diagnosed with SIAD-associated hyponatremia between March and August 2025. Patients who received SGLT2i during treatment were included. Data on demographics, laboratory values (including serum sodium levels), and treatment outcomes were collected. The primary outcome was the change in serum sodium after SGLT2i initiation. Statistical analyses were performed using paired t-tests, with p < 0.05 considered significant.
Results: The mean baseline serum sodium was 122.4 ± 4.8 mmol/L. Within 72 hours of starting SGLT2i therapy, the mean sodium level increased to 129.1 ± 3.9 mmol/L (p < 0.001), with 72% of patients achieving normonatremia (≥135 mmol/L) within one week. The mean sodium increase at 72 hours was +6.7 ± 2.8 mmol/L. Mild, self-limited polyuria occurred in 16% of patients. No serious adverse events, volume depletion, or renal function deterioration were observed.
Conclusion: SGLT2i significantly improved serum sodium levels in patients with SIAD-associated hyponatremia, demonstrating a favorable safety and tolerability profile. These findings suggest that SGLT2i may offer a viable, accessible alternative to traditional therapies for managing hyponatremia in SIAD. Prospective randomized trials are needed to confirm these results and establish long-term safety and efficacy.
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