Protein Supplementation in Thiazide-induced Hyponatremia

Exclusion Criteria

• •Pregnancy
• •estimated glomerular filtration rate (eGFR) \<45 ml/min/1.75 m2,
• •Other causes of hyponatremia (liver cirrhosis, uncontrolled hypothyroidism, adrenal insufficiency)
• •unable to provide informed consent;
• •patients with generalized volume overload who may require immediate changes in diuretic therapy (at the discretion of treating HTN specialist);
• •patients taking drugs which may interfere with urinary sodium excretion (such as carbamazepine, loop diuretics, potassium sparing diuretics, mineralocorticoid and glucocorticosteroids, selective serotonin receptor inhibitors, tricyclic antidepressants, amiodarone, and lithium);
• •patients with moderate to severe hyponatremia (Plasma sodium concentration \< 125 mmol/L) who may require immediate discontinuation of the thiazide diuretic .