Does Toradol Lower Sodium Levels?
No, Toradol (ketorolac) does not directly lower serum sodium levels. However, ketorolac can cause hyperkalemia (elevated potassium) and reduced potassium excretion, which are distinct electrolyte disturbances unrelated to sodium 1.
Electrolyte Effects of Ketorolac
Potassium, Not Sodium
- The primary electrolyte concern with ketorolac is hyperkalemia, not hyponatremia 2.
- In postoperative patients receiving ketorolac 10 mg every 4 hours, the only significant renal effect was reduced excretion of potassium compared to placebo 1.
- Case reports document acute hyperkalemia developing in patients treated with ketorolac, particularly in those with pre-existing renal vulnerability 2.
Mechanism of Electrolyte Disturbance
- Ketorolac, like all NSAIDs, inhibits prostaglandin synthesis, which can impair renal function in susceptible patients 2.
- This prostaglandin inhibition affects renal hemodynamics and tubular function, leading to potassium retention rather than sodium wasting 2, 1.
Renal Complications to Monitor
Acute Kidney Injury Risk
- Acute renal failure is a recognized complication of ketorolac use, particularly in high-risk populations 3, 4.
- The risk is particularly elevated in patients with marginal baseline kidney function, such as those with sickle cell crisis 5, 6.
- Renal impairment from ketorolac is usually reversible upon drug discontinuation 3, 2.
High-Risk Patient Populations
- Patients ≥60 years of age require cautious use 7.
- Those with compromised fluid status or pre-existing renal impairment are at increased risk 7, 6.
- Patients on concomitant nephrotoxic drugs should be monitored closely 7.
Monitoring Recommendations
When initiating ketorolac therapy, monitor:
- Baseline and periodic BUN and creatinine 7.
- Serum potassium levels (not sodium) for hyperkalemia 2, 1.
- Blood pressure, liver function tests, CBC, and fecal occult blood 7.
- Repeat monitoring every 3 months for long-term therapy (though duration should not exceed 5 days for parenteral use) 7.
Clinical Pitfalls to Avoid
- Do not confuse ketorolac's electrolyte effects with diuretic-induced hyponatremia—ketorolac causes the opposite problem (potassium retention, not sodium loss) 2, 1.
- Limit treatment duration to ≤5 days to minimize renal complications 7, 3, 4.
- Use maximum daily dose of 120 mg in adults and avoid exceeding recommended dosing 7.
- Avoid ketorolac in patients with active renal impairment where prostaglandin-mediated renal perfusion is critical 2.