662. Voriconazole-Associated Severe Hyponatremia
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Voriconazole is the drug of choice for invasive aspergillosis. Although visual hallucinations, hepatotoxicity, and rash are relatively common during voriconazole therapy, severe hyponatremia has been rarely reported.

Methods: During a year, 34 patients treated with voriconazole were monitored for side effects. Therapeutic drug monitoring of voriconazole (therapeutic range 1~5.5 mg/L) and CYP2C19 genotyping were done.

Results: We experienced 9% (3/34) of severe hyponatremia associated with voriconazole therapy.

Patient 1, a 66-year-old man with aplastic anemia, developed invasive pulmonary aspergillosis. On day 10 of voriconazole therapy, the patient showed drowsy mentality and sodium level of 118 mmol/L. The trough voriconazole concentration on day 14 of therapy was high (9.94 µg/mL). The sodium level was corrected to normal, 4 days after reducing voriconazole to a half dose. The CYP2C19 genotype was classified as heterozygous extensive metabolizer (*1/*2).

Patient 2, a 62-year-old woman with lymphoma, developed invasive pulmonary aspergillosis. Seven days after voriconazole therapy, the patient became confused. The sodium level was 116 mmol/L. Despite infusion of 3% saline, the hyponatermia was not corrected and the patient expired due to rapidly progressing respiratory failure on day 7 of voriconazole therapy. The trough voriconazole level on day 5 was high (6.12 µg/mL). The CYP2C19 genotype was homozygous extensive metabolizer (*1/*1).

Patient 3, a 70-year-old man with myelodysplastic syndrome and a past history of long-term steroid use due to arthritis, developed invasive pulmonary aspergillosis. On day 6 of therapy, the patient was confused and his sodium level was 118 mmol/L. Two days after voriconazole was discontinued and 3% saline infused, the patient's mental status and hyponatremia recovered. The trough voriconazole concentration on day 5 of therapy was within the therapeutic range (4.14 µg/mL). The CYP2C19 genotype was heterozygous extensive metabolizer (*1/*2).

Conclusion: If hyponatremia is detected during voriconazole therapy, voriconazole-associated hyponatremia should be suspected and an adjustment of the voriconazole dose should be considered according to the trough voriconazole level.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Kye-Hyung Kim, MD , Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Pyoeng Gyun Choe, MD , Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Jin-su Song, MD , Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Jinyong Park, MD , Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Nak-Hyun Kim, MD , Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Jongyoun Yi, MD , Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
Kyoung-Ho Song, MD , Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Sang-Won Park, MD, PhD , Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Hong Bin Kim, MD, PhD , Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam, South Korea
Nam Joong Kim, MD, PhD , Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Wan Beom Park, MD, PhD , Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
Myoung-don Oh, MD, PhD , Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

Disclosures:

K. H. Kim, None

P. G. Choe, None

J. S. Song, None

J. Park, None

N. H. Kim, None

J. Yi, None

K. H. Song, None

S. W. Park, None

H. B. Kim, None

N. J. Kim, None

W. B. Park, None

M. D. Oh, None

See more of: Mycology
See more of: Abstracts

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 21 with the exception of research findings presented at IDSA press conferences.

 
 
   
 

Copyright IDSA 2009 Infectious Diseases Society of America 1300 Wilson Boulevard, Suite 300 Arlington, VA 22209 info@idsociety.org