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ISSUE 2 APRIL
Letters to the Editor

Tramadol

  • Huy A. Tran

The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

 

Tramadol

Editor, – I read with interest the addition of tramadol to the already long list of medications that cause the syndrome of inappropriate antidiuretic hormone secretion (SIADH) (Aust Prescr 2004;27:97). The temporal relationship between serum sodium level and tramadol use appears to have secured the diagnosis.

While not so relevant to the elderly population, SIADH is essentially a diagnosis of exclusion where, in the presence of normovolaemia, other sinister (if not treatable) causes have been excluded.1 It is important that readers should not get the impression that the diagnosis is based on solitary serum sodium and osmolality measurements. It is critical that, together with other osmotically active analytes, urinary sodium and urinary osmolality are measured in parallel in the overall assessment of hyponatraemia. This will assist in further understanding the pathophysiology which remains, as stated, hypothetical at this stage.

Huy A. Tran
Head, Department of Clinical Chemistry
Hunter Area Pathology Service
John Hunter Hospital
Newcastle, NSW

 

References

  1. Robinson AG, Verbalis JG. Posterior pituitary gland. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, editors. Williams textbook of endocrinology. 10th ed. Philadelphia: W.B. Saunders; 2003. p. 281-329.

Huy A. Tran

Head, Department of Clinical Chemistry, Hunter Area Pathology Service, John Hunter Hospital Newcastle, NSW