GP CCE Cases · kidney-and-urinary-health
Thiazide-associated hyponatraemia — CCE clinical encounter
CCE-style clinical encounter: an 80-year-old woman brought in by her daughter after falls and confusion, on a thiazide for years. The candidate must connect the drug to the sodium, examine and investigate systematically, switch therapy safely, and set monitoring that prevents the next fall.
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Prompt
An 80-year-old woman attends with her daughter, who reports three falls in six weeks, new confusion, and 'she's just not herself'. Medications: bendroflumethiazide (8 years), amlodipine, paracetamol. Sodium result from last week in her notes: 127 mmol/L, never actioned. The daughter asks: 'Is it her age, or the tablets?'
Objectives
- Connect the falls-confusion cluster to the sodium and the drug — the thiazide is the working diagnosis until excluded. [4]
- Take the daughter's concern seriously and answer the age-versus-tablets question directly with data. [4]
- Examine for volume status, falls risk and cognitive state; review all medications. [2]
- Act on the previously ignored sodium result — repeat, confirm, and manage per severity. [2]
- Establish monitoring that prevents recurrence: sodium check after any antihypertensive change, falls-risk review. [4]
References4ShowHide
- [2]Adrogué HJ, Tucker BM, Madias NE Diagnosis and Management of Hyponatremia: A Review. JAMA, 2022.PMID 35852524
- [4]Andersson NW, Wohlfahrt J, Feenstra B et al. Cumulative Incidence of Thiazide-Induced Hyponatremia : A Population-Based Cohort Study. Annals of internal medicine, 2024.PMID 38109740
- [1]Garrahy A, Galloway I, Hannon AM et al. Fluid Restriction Therapy for Chronic SIAD; Results of a Prospective Randomized Controlled Trial. The Journal of clinical endocrinology and metabolism, 2020.PMID 32879954
- [6]Warren AM, Grossmann M, Hoermann R et al. Tolvaptan vs Fluid Restriction in Moderate-Profound Hyponatremia: An Open-Label Randomized Clinical Trial. The Journal of clinical endocrinology and metabolism, 2026.PMID 40720585