Begagić E, Bečulić H, Mašović A, Alić F, Huremović M, Vranić S. Carbamazepine-induced hyponatremia following meningioma surgery: A case report. World J Clin Cases 2026; 14(9): 118634 [DOI: 10.12998/wjcc.v14.i9.118634]
Corresponding Author of This Article
Emir Begagić, MD, Principal Investigator, Department of Neurosurgery, Cantonal Hospital Zenica, Crkvice 67, Zenica 72000, Bosnia and Herzegovina. emir.begagic@dl.unze.ba
Research Domain of This Article
Neurosciences
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Case Report
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Mar 26, 2026 (publication date) through Mar 27, 2026
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Publication Name
World Journal of Clinical Cases
ISSN
2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Begagić E, Bečulić H, Mašović A, Alić F, Huremović M, Vranić S. Carbamazepine-induced hyponatremia following meningioma surgery: A case report. World J Clin Cases 2026; 14(9): 118634 [DOI: 10.12998/wjcc.v14.i9.118634]
Emir Begagić, Hakija Bečulić, Anes Mašović, Fahrudin Alić, Department of Neurosurgery, Cantonal Hospital Zenica, Zenica 72000, Bosnia and Herzegovina
Emir Begagić, Hakija Bečulić, Department of General Medicine, University of Zenica, Zenica 72000, Bosnia and Herzegovina
Mirza Huremović, Department of Emergency Medicine, Cantonal Hospital Zenica, Zenica 72000, Bosnia and Herzegovina
Semir Vranić, College of Medicine, Qatar University, Doha 2713, Ad Dawah, Qatar
Author contributions: Begagić E designed the research study; Begagić E, Bečulić H, Mašović A, and Alić F performed the research; Bečulić H and Vranić S supervised the research; Begagić E, Bečulić H, Mašović A, Alić F, Huremović M, and Vranić S wrote the manuscript; and all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Emir Begagić, MD, Principal Investigator, Department of Neurosurgery, Cantonal Hospital Zenica, Crkvice 67, Zenica 72000, Bosnia and Herzegovina. emir.begagic@dl.unze.ba
Received: January 12, 2026 Revised: February 12, 2026 Accepted: February 27, 2026 Published online: March 26, 2026 Processing time: 76 Days and 6.4 Hours
Abstract
BACKGROUND
Hyponatremia is a common postoperative electrolyte disturbance in neurosurgical patients and may present with nonspecific neurocognitive symptoms that overlap with intracranial complications. Carbamazepine (CBZ), frequently used for seizure prophylaxis and pain syndromes, is a recognized cause of drug-induced hyponatremia with a syndrome of inappropriate antidiuretic hormone secretion (SIADH)-like profile.
CASE SUMMARY
A 62-year-old woman underwent elective left supraorbital craniotomy and microsurgical resection of a left anterior skull-base meningioma. Postoperatively, CBZ 400 mg was initiated twice daily for antiseizure prophylaxis. On postoperative day (POD) 2, she developed somnolence and cognitive slowing with serum sodium 131 mmol/L, which progressed to 123 mmol/L (POD 3) and 119 mmol/L (POD 7) despite isotonic saline and increased dietary sodium. Hypertonic saline (3% NaCl) was introduced with partial correction. Evaluation confirmed hypotonic hyponatremia (serum osmolality 254 mOsm/kg) with inappropriately concentrated urine (urine osmolality 560 mOsm/kg) and elevated urine sodium (68 mmol/L) in a clinically euvolemic patient; thyroid and adrenal functions were normal. Given the temporal association and SIADH-like pathophysiology, CBZ-induced hyponatremia was considered the most likely etiology. CBZ was discontinued and replaced with levetiracetam (titrated to 500 mg twice daily), followed by clinical improvement and steady sodium normalization (132 mmol/L at discharge; 136 mmol/L by POD 19), remaining normal at three-month follow-up. We searched PubMed and Google Scholar to for relevant literature review.
CONCLUSION
This case highlights CBZ as a potentially reversible cause of significant postoperative hyponatremia after meningioma surgery. Early sodium monitoring after CBZ initiation and prompt substitution with alternative antiseizure therapy should be considered when euvolemic hypotonic hyponatremia develops in the postoperative period.
Core Tip: A 62-year-old woman developed progressive symptomatic hypotonic euvolemic hyponatremia after frontobasal meningioma resection shortly after starting carbamazepine (CBZ) for postoperative seizure prophylaxis. Despite isotonic saline, sodium fell to 119 mmol/L with somnolence; investigations supported a syndrome of inappropriate antidiuretic hormone secretion like pattern. Discontinuation of CBZ with substitution to levetiracetam, alongside hypertonic saline, led to clinical recovery and sustained normalization of serum sodium.
