Hyponatremia Due to an Interaction Between Hydromorphone and Desmopressin in a Patient with Central Diabetes Insipidus: A Case Report
Bibliographic record
Abstract
There are case reports of opiate-induced hyponatremia thought to be mediated by increased secretion of antidiuretic hormone. We report a case of hyponatremia in a woman with central diabetes insipidus treated with desmopressin after receiving large doses of hydromorphone which suggests a different mechanism of opiate action. A 55-year-old woman with central diabetes insipidus presented to hospital with an asthma exacerbation, later complicated by intestinal perforation requiring surgery. She received hydromorphone for pain for 3 weeks before surgery, but her requirements increased after surgery. Her serum sodium subsequently decreased, reaching a nadir of 119 mmol/L. Hydromorphone and desmopressin were discontinued, and she was managed with fluid restriction, a 3% saline infusion and intravenous vasopressin. This suggests that hydromorphone may interact with desmopressin to potentiate its antidiuretic effect. Furthermore, hydromorphone may contribute to hyponatremia by another mechanism rather than by increasing production of antidiuretic hormone.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".