Nicotine Replacement Therapy-associated Syndrome
Nicotine has been documented to regulate the release of plasma arginine vasopressin (AVP). The literature is inconclusive about the effects of nicotine replacement therapy on AVP release, although cigarette smoking has been shown to increase the release of AVP. No clinical case reports have documented the possible association between nicotine replacement and hyponatremia through AVP release. We report a case of a 39-year-old man who experienced syndrome of inappropriate antidiuretic hormone while on nicotine patch therapy. We theorize that the constant serum concentration of nicotine levels provided through the patch may cause hyponatremia through the continuous stimulation of vasopressin.

Nicotine's numerous effects on the central nervous system are neuroregulatory in nature. When nicotine is ingested or administered (through cigarette smoking or nicotine replacement therapy), its centrally mediated effects increase in a dose-dependent manner as plasma levels rise. These effects result from an increased secretion of hormones from the pituitary gland. It is well documented that nicotine may play a role in the nonosmotic release of plasma arginine vasopressin (AVP) from the posterior pituitary. We report the case of a patient who experienced hyponatremia and syndrome of inappropriate antidiuretic hormone (SIADH) after the administration of a nicotine patch.