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Indian Journal of Medical Sciences, Vol. 60, No. 4, April, 2006, pp. 158-159 Letter To Editor Cefoperazone / Sulbactam induced hyponatremia Souvik Mitra*, Sujit Basu** * Final Year Medical Student,
Medical College Calcutta, 88 College Street, Kolkata - 700073, India **Department
of Medical Oncology, Chittaranjan National Cancer Institute, 37 S. P. Mukherjee
Road, Kolkata - 700 026, India Code Number: ms06024 Sir, Cefoperazone is a commonly used broad spectrum semi-synthetic third-generation cephalosporin with a potent bactericidal activity against a wide range of gram-positive and gram-negative bacteria.[1] We here like to report a case of hyponatremia induced by cefoperazone/sulbactam. A 70 - year old female presented with high fever (103°F), dysuria, urgency and frequency of micturation. Investigations revealed: hemoglobin 11 g/dl, total leukocyte count (TLC) 12.1 x 10 9/L (neutrophils 90%, lymphocytes 10%) and her urine analysis confirmed E. coli infection. She had no significant past medical history. As her urine culture and sensitivity test reported the bacterium to be highly sensitive to cefoperazone/sulbactam, she was therefore treated with cefoperazone/sulbactam combination (2 gm bid. i.v. every 12 hours). Following the second dose of the injection, the patient became drowsy. Her serum sodium level was 116 mEq/L, plasma osmolality was 240 mOsm per kg, urine osmolality was 330 mOsm/kg. She had low blood urea nitrogen (BUN)/creatinine ratio. The chest X-ray, CT scan of the brain, lipid profile, blood glucose, serum potassium, chloride, biocarbonate, bilirubin, ALT, AST, serum proteins, adrenal and thyroid function tests were normal. Because no other causes of hyponatremia could be ascertained in this patient, therefore cefoperazone/sulbactam was withdrawn from the treatment schedule and she was fluid restricted to 1 L/day. Her serum sodium gradually normalized. The suspicion of cefoperazone/sulbactam induced hyponatremia was further confirmed when a similar hyponatremic episode occurred in this patient (serum sodium level 118 mEq/L, plasma osmolality 260 mOsm/kg and urine osmolality of 300 mOsm/kg), when she was again treated for acute UTI with cefoperazone/sulbactam 6 months after the above mentioned initial episode. Her hyponatremia also normalized on that occasion following stoppage of cefoperazone/sulbactam. The laboratory reports in this patient on both the occasions also suggested that the hyponatremia was due to inappropriate antidiuretic hormone secretion.[2] This combination was particularly used for the second time because the cause of the prior episode was only a suspicion and most importantly, her bacterial cultural sensitivity tests were markedly sensitive to these drugs, the other antibiotics were either mildly sensitive or resistant. Although there are several causes of hyponatremia, however in the case presented here, occurrences of hyponatremia following cefoperazone treatment, and the normalization of hyponatremia after stoppage of the drug on two separate occasions are strong evidences in support of the role of cefoperazone in the development of hyponatremia. Finally, application of the Naranjo probability score (≥ 9) indicated a highly probable relationship between hyponatremia secondary to cefoperazone therapy in this patient.[3] The known adverse effects of cefoperazone are reported to be thrombocytopenia, neutropenia, gastrointestinal hemorrhage, hemolytic anemia and Stevens Johnson syndrome.[4],[5] There are also reports of transient drug-induced fever, diarrhea and rash associated with this drug.[5] Although drug induced hyponatremia has been reported before,[2] but to our knowledge, this is a rare case of hyponatremia induced by cefoperazone/sulbactam combination. Finally, hyponatremia is a serious disorder,[2] therefore the probability of this adverse effect should be considered while treating patients with cefoperazone/sulbactam combination. References
Copyright 2006 - Indian Journal of Medical Sciences |
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