Hyponatremia after intravenous zoledronic acid administration: A case report

Background

Bisphosphonates are an antiresorptive agent approved to treat numerous skeletal disorders, including osteoporosis (postmenopausal and steroid-induced), malignancy-associated bone disease, and Paget's bone disease. The three most commonly used intravenous (IV) bisphosphonates for these treatments are zoledronate, ibandronate, and pamidronate. IV bisphosphonates for PMO have the advantage of better adherence to treatment compared to daily oral therapy.

Case report

A 77-year-old female patient presented to the emergency department (ED) with complaints of nausea and vomiting for one day. In the patient's history, it was learned that she had been using 4 mg zoledronic acid IV every four weeks for three months. Symptomatic hyponatremia was detected according to the patient's laboratory results and clinic. Since the patient had symptomatic hyponatremia, 150ml 3 ​% sodium chloride infusion was given. In addition, hydration was continued as she had metabolic alkalosis due to vomiting. The patient, whose symptoms decreased, was hospitalized for follow-up and treatment.

Why should an emergency physician be aware of this?

ED physicians and other clinicians should be aware that gastrointestinal symptoms such as nausea and vomiting may occur after intravenous administration of zoledronate and that symptoms may be the cause or result of hyponatremia. In these cases, laboratory examinations, appropriate treatments, and hospitalization should be performed for the necessary patients.