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Increased Risk of Drug-Induced Hyponatremia during High Temperatures

Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping 587 58, Sweden
Department of Clinical Pharmacology, Department of Medical and Health Sciences, Linköping University, Linköping 581 85, Sweden
Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå 901 85, Sweden
Department of Endocrinology, Department of Medical and Health Sciences, Linköping University, Linköping, 581 85, Sweden
Institute of Public Health, Heidelberg University, Heidelberg, 691 20, Germany
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2017, 14(7), 827;
Received: 2 May 2017 / Revised: 17 July 2017 / Accepted: 18 July 2017 / Published: 22 July 2017
(This article belongs to the Special Issue Climate Change and Human Health)
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Purpose: To investigate the relationship between outdoor temperature in Sweden and the reporting of drug-induced hyponatremia to the Medical Products Agency (MPA). Methods: All individual adverse drug reactions (ADR) reported to MPA from 1 January 2010 to 31 October 2013 of suspected drug-induced hyponatremia and random controls were identified. Reports where the ADR had been assessed as having at least a possible relation to the suspected drug were included. Information on administered drugs, onset date, causality assessment, sodium levels, and the geographical origin of the reports was extracted. A case-crossover design was used to ascertain the association between heat exposure and drug-induced hyponatremia at the individual level, while linear regression was used to study its relationship to sodium concentration in blood. Temperature exposure data were obtained from the nearest observation station to the reported cases. Results: During the study period, 280 reports of hyponatremia were identified. More cases of drug-induced hyponatremia were reported in the warmer season, with a peak in June, while other ADRs showed an opposite annual pattern. The distributed lag non-linear model indicated an increasing odds ratio (OR) with increasing temperature in the warm season with a highest odds ratio, with delays of 1–5 days after heat exposure. A cumulative OR for a lag time of 1 to 3 days was estimated at 2.21 at an average daily temperature of 20 °C. The change in sodium per 1 °C increase in temperature was estimated to be −0.37 mmol/L (95% CI: −0.02, −0.72). Conclusions: Warm weather appears to increase the risk of drug-induced hyponatremia View Full-Text
Keywords: average daily temperature; hyponatremia; adverse drug reaction average daily temperature; hyponatremia; adverse drug reaction

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Jönsson, A.K.; Lövborg, H.; Lohr, W.; Ekman, B.; Rocklöv, J. Increased Risk of Drug-Induced Hyponatremia during High Temperatures. Int. J. Environ. Res. Public Health 2017, 14, 827.

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