Hyponatremia and Selective Serotonin Reuptake Inhibitors

Aims:Hyponatremia (HPN) is a potentially lethal electrolytic disturbance. Certain medical treatments are integrated in the etiology of that sodium disorder. We retrospectively studied the rate of HPN in patients examined in the emergency room (ER) of Alexandra Hospital receiving a selective serotonin reuptake inhibitor (SSRI).Methods:17,410 patients, 55.54% women and 44.46% men were examined in the ER over a one year period. 281 patients (1,61% of total) presented with HPN, 162 were women (57.6%) and 121 (42.3%) men. Plasma Sodium values ≤ 133mEq/l defined HPN. 13 of the 281 patients with HPN (4.6%) with no renal, heart or hepatic impairment were on an SSRI regimen.Results:11 of 162 women (6.8%) presented with HPN were receiving concurrently SSRI and either thiazide diuretic (3 ) or furosemide (2 ). 2 of 121 men (1.65%) were on SSRI regimen and furosemide. SSRI dosage was in all cases within suggested therapeutic limits. Table 1 demonstrates mean values and standard deviation of all the parameters examined.PatientsAgePlasma Na+Plasma K+Plasma CreatininePlasma UreaHct1366,9 +/- 17,4 years127,2 +/- 6,1 mEq/4 +/- 0,7 mEq/l1.06 +/-0,5 mg%39,8 +/- 16,2 mg%36,7 +/ 2,9%Conclusion:SSRI therapy presents a potential cause for HPN principally in women older than 65 years old with increasing risk when diuretic is used concomitantly. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and expression conversion of aquaporin-2 receptors of the collecting ducts are two possible pathophysiologic mechanisms of HPN occurrence.

Download Full-text

Hyponatremia with Venlafaxine

Annals of Pharmacotherapy ◽

10.1345/aph.17117 ◽

1998 ◽

Vol 32 (1) ◽

pp. 49-51 ◽

Cited By ~ 26

Author(s):

Gule Rana Masood ◽

Shyam D Karki ◽

William R Patterson

Keyword(s):

Serotonin Reuptake ◽

White Woman ◽

Selective Serotonin Reuptake Inhibitors ◽

Temporal Relationship ◽

Potential Problem ◽

Potent Inhibitor ◽

Hormone Secretion ◽

Inappropriate Antidiuretic Hormone Secretion ◽

Antidiuretic Hormone Secretion ◽

Case Summary

OBJECTIVE To describe a patient with hyponatremia associated with venlafaxine therapy. CASE SUMMARY: A 92-year-old white woman who was receiving venlafaxine for management of depression was found to have hyponatremia. A detailed workup confirmed the diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). A temporal relationship between initiation of venlafaxine therapy and the onset of hyponatremia indicated it as the probable cause. Venlafaxine was discontinued, and hyponatremia resolved within a few weeks. DISCUSSION: Hyponatremia has been reported with selective serotonin-reuptake inhibitors (SSRIs). Serotonin has been reported to elevate concentrations of vasopressin in animal models. Venlafaxine is a potent inhibitor of serotonin reuptake and may have adverse effects similar to those of SSRIs. CONCLUSIONS We report a case of hyponatremia probably caused by venlafaxine. Awareness of this potential problem would be helpful to clinicians and should be considered in the differential diagnosis of hyponatremia. OBJETIVO Informar el caso de un paciente con hiponatremia asociada al tratamiento con venlafaxine. RESUMEN Una mujer de 92 años en tratamiento con venlafaxine para el manejo de depresión desarrolló hiponatremia. Sus otros medicamentos concurrentes incluían fenobarbital 120 mg al acostarse, enalapril 10 mg/d, furosemida 20 mg/d, carbonato de calcio 650 mg dos veces al día, y nortriptilina 50 mg al acostarse. Una evaluación detallada confirmó el diagnóstico del síndrome inadecuado de la hormona antidiurética. La relación temporal entre el inicio del tratamiento con venlafaxine y el inicio de la hiponatremia tiende a señalar a este medicamento como el causante. Al descontinuar el venlafaxine la hiponatremia se resolvió en unas pocas semanas. DISCUSIÓN La hiponatremia ha sido asociada con los inhibidores selectivos de la recaptación de serotonina (ISRS). En modelos de animales se ha demostrado que la serotonina eleva los niveles de vasopresina. Venlafaxine es un inhibidor potente de la recaptación de serotonina y puede tener efectos adversos similares a los de los ISRS. CONCLUSIONES: Se informó un caso de hiponatremia probablemente causada por venlafaxine. Desde que se sometió este informe han sido publicados tres informes similares de hiponatremia atribuídos a este antidepresivo. Esto sugiere que venlafaxine puede causar hiponatremia. vasopresina. Venlafaxine es un inhibidor potente de la recaptación de serotonina y puede tener efectos adversos similares a los de los ISRS. CONCLUSIONES: Se informó un caso de hiponatremia probablemente causada por venlafaxine. Desde que se sometió este informe han sido publicados tres informes similares de hiponatremia atribuídos a este antidepresivo. Esto sugiere que venlafaxine puede causar hiponatremia. Este hecho debe ser considerado al hacer el diagnóstico diferencial de cualquier paciente que desarrolle hiponatremia mientras esté utilizando este medicamento. Este hecho debe ser considerado al hacer el diagnóstico diferencial de cualquier paciente que desarrolle hiponatremia mientras esté utilizando este medicamento.

Download Full-text

Change in profile of acute self drug-poisonings over a 10–year period

Human & Experimental Toxicology ◽

10.1191/0960327104ht487oa ◽

2004 ◽

Vol 23 (11) ◽

pp. 507-511 ◽

Cited By ~ 21

Author(s):

Frédérik Staikowsky ◽

Florence Theil ◽

Paule Mercadier ◽

Séebastien Candella ◽

Jean Pierre Benais

Keyword(s):

Public Health ◽

Emergency Department ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Emergency Department Visits ◽

Serotonin Reuptake Inhibitors ◽

Selective Serotonin ◽

Drug Poisoning ◽

One Year

All acute, deliberate, drug-poisoning-related emergency department visits over two periods of one year, 1992-1993 (P1) and 2001-2002 (P2), were reviewed to investigate trends in substances used for acute self drug-poisonings over a 10-year period. For P1 and P2 respectively, 804 and 830 episodes of acute self drug-poisonings were compared. For the two studied periods, psycholeptic drugs predominated (78 and 77%); however, benzodiazepines declined (67 to 55%; P <0.01) and antidepressants in-creased (9.5 to 15%; P <0.01). Moreover, the type of antidepressant changed markedly with a decrease of the imipraminic antidepressants (48.4 to 10.7%) and an increase of selective serotonin reuptake inhibitors (31.2 to 74%). The proportion of benzodiazepine-related drugs increased with time (7.9 to 14.1%). The proportion of analgesics was 5.4% for P1 and 7.3% for P2; paracetamol, alone or associated to other compounds, remained the most incriminated. Nevertheless, opioids were more often mentioned during the later period (11.6 to 24.5%). The trend of the different pharmacological families used in acute self drug-poisonings is not fundamentally different over a 10-year period. However, there are some qualitative modifications, which are important for readjusting the emergency physician's toxicological knowledge and public health actions.

Download Full-text