Can meropenem (Merrem) cause hyponatremia?

Meropenem Is Not a Known Cause of Hyponatremia

Based on the available evidence, meropenem (Merrem) is not established as a cause of hyponatremia. While antibiotics can sometimes affect electrolyte balance, there is no specific evidence linking meropenem to hyponatremia in the medical literature provided.

Evidence Review

What We Know About Meropenem

Meropenem is a broad-spectrum carbapenem antibiotic used for serious bacterial infections including:

• Complicated intra-abdominal infections
• Complicated skin and skin structure infections
• Bacterial meningitis
• Nosocomial pneumonia
• Septicemia
• Febrile neutropenia 1

Documented Side Effects of Meropenem

The most commonly reported adverse effects of meropenem include:

• Diarrhea (2.3%)
• Rash (1.4%)
• Nausea/vomiting (1.4%)
• Injection site inflammation (1.1%)
• Laboratory abnormalities such as thrombocytosis (1.6%)
• Increased hepatic enzymes (1.5-4.3%) 2

Notably, hyponatremia is not listed among the common or significant adverse effects of meropenem in the comprehensive safety profile review of nearly 5,000 patients 2.

Potential Electrolyte Disturbances

While there is one case report mentioning hypokalemia associated with meropenem administration 3, there are no documented cases or studies linking meropenem specifically to hyponatremia.

Causes of Hyponatremia in Hospitalized Patients

Hyponatremia in hospitalized patients, particularly those with serious infections requiring antibiotics like meropenem, is more commonly associated with:

1. Underlying disease processes:

   • Cirrhosis with ascites causes dilutional hyponatremia due to impaired free water excretion 4
   • Heart failure leading to hypervolemic hyponatremia 4

2. Medication-related causes (not including meropenem):

   • Diuretics (especially thiazides)
   • Antidepressants (particularly SSRIs)
   • Antiepileptic drugs
   • NSAIDs 4

3. Other factors:

   • Excessive hypotonic fluid administration
   • SIADH (Syndrome of Inappropriate ADH secretion)
   • Renal failure 4

Clinical Implications

When evaluating hyponatremia in a patient receiving meropenem:

• Look for other more established causes of hyponatremia
• Consider the timing of hyponatremia in relation to other medications and clinical conditions
• Evaluate volume status to determine if hyponatremia is hypovolemic, euvolemic, or hypervolemic
• Check other electrolytes, as meropenem has been associated with hypokalemia in rare cases 3

Conclusion

While monitoring electrolytes is important during antimicrobial therapy, the available evidence does not support meropenem as a direct cause of hyponatremia. Clinicians should focus on other more established causes when investigating hyponatremia in patients receiving meropenem.