Delayed Recurrent SIADH Associated with SSRIs

2002 ◽  
Vol 36 (7-8) ◽  
pp. 1175-1177 ◽  
Author(s):  
Zeev H Arinzon ◽  
Yehoshua A Lehman ◽  
Zeev G Fidelman ◽  
Irina I Krasnyansky
Keyword(s):  
Elderly Patients ◽  
Antidiuretic Hormone ◽  
Serum Sodium ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Sodium Concentration ◽  
Plasma Sodium ◽  
Probability Scale ◽  
Depressed Woman ◽  
Case Summary

BACKGROUND: Depression is a common problem in elderly patients and is frequently treated with selective serotonin-reuptake inhibitors (SSRIs). OBJECTIVE: To report a case of delayed recurrent hyponatremia after switching from one SSRI to another. CASE SUMMARY: An 87-year-old depressed woman began treatment with fluvoxamine. One week later, she was diagnosed with hyponatremia, most likely syndrome of inadequate antidiuretic hormone. Following discontinuation of fluvoxamine, the serum sodium concentration normalized. Later, she began treatment with paroxetine. Sixteen months after initiating paroxetine, she developed symptomatic recurrent hyponatremia. After paroxetine was discontinued, the sodium concentration normalized. DISCUSSION: In this case, unlike those previously reported, hyponatremia recurred 16 months after a different SSRI was initiated. The Naranjo probability scale indicates a probable relationship between recurrent hyponatremia and paroxetine. The mechanism of SSRI-induced hyponatremia is multifactorial. CONCLUSIONS: This case illustrates that replacement of one SSRI with another can cause delayed, recurrent hyponatremia in elderly patients. Plasma sodium concentrations must be monitored, not only in the first weeks of treatment, but throughout the full course.

scholarly journals Syndrome of Inappropriate Secretion of Antidiuretic Hormone due to Selective Serotonin Reuptake Inhibitors After Pancreaticoduodenectomy for Carcinoma of the Ampulla of Vater: Case Report

2013 ◽  
Vol 98 (4) ◽  
pp. 289-291
Author(s):  
Ryota Iwase ◽  
Hiroaki Shiba ◽  
Takeshi Gocho ◽  
Yasuro Futagawa ◽  
Shigeki Wakiyama ◽  
...  
Keyword(s):  
Antidiuretic Hormone ◽  
Serum Sodium ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Plasma Osmolality ◽  
Sodium Concentration ◽  
Ampulla Of Vater ◽  
Serum Sodium Concentration ◽  
Selective Serotonin ◽  
Inappropriate Secretion

Abstract A 68-year-old man underwent pancreaticoduodenectomy with lymph nodes dissection for carcinoma of the ampulla of Vater. The patient had anxiety neurosis and had been treated with a selective serotonin reuptake inhibitor (SSRI). Postoperatively, SSRI was resumed on postoperative day 2. His serum sodium concentration gradually decreased, and the patient was given a sodium supplement. However, 11 days after the operation, laboratory findings included serum sodium concentration of 117 mEq/L, serum vasopressin of 2.0 pg/mL, plasma osmolality of 238 mOsm/kg, urine osmolality of 645 mOsm/kg, urine sodium concentration of 66 mEq/L, serum creatinine concentration of 0.54 mg/dL, and serum cortisol concentration of 29.1 μg/dL. With a diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH), the antianxiety neurosis medication was changed from the SSRI to another type of drug. After switching the medication, the patient made a satisfactory recovery with normalization of serum sodium by postoperative day 20.

Case Report of SIADH Associated With Escitalopram Use

2009 ◽  
Vol 22 (6) ◽  
pp. 594-599 ◽  
Author(s):  
Renee R. Koski ◽  
Jill A. Covyeou ◽  
Michelle Morissette
Keyword(s):  
Risk Factors ◽  
Antidiuretic Hormone ◽  
Serum Sodium ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Case Reports ◽  
Treatment Options ◽  
Sodium Concentration ◽  
Serum Sodium Concentration ◽  
White Female ◽  
Fluid Restriction

The authors report a case of syndrome of inappropriate antidiuretic hormone (SIADH) associated with the use of escitalopram in an elderly female patient. A 97-year-old white female was admitted to the hospital for a suspected vertebral fracture and hyponatremia. Her serum sodium concentration was 113 mEq/L (113 mmol/L) at admission. She was started on escitalopram 5 mg daily 1 week prior to admission for anxiety. During admission, her laboratory tests revealed serum hyponatremia and hypo-osmolality and urine hyperosmolality and hypernatremia. Her escitalopram was stopped, and she was diagnosed with syndrome of inappropriate antidiuretic hormone. She was treated with hypertonic (3%) saline. She was discharged 1 week later with a serum sodium concentration of 121 mEq/L (121 mmol/L). There have been hundreds of case reports of SIADH associated with selective serotonin reuptake inhibitors (SSRIs), including 5 cases associating escitalopram with syndrome of inappropriate antidiuretic hormone. The median time to onset of SIADH after initiating SSRIs is approximately 2 weeks. Risk factors include advanced age, concomitant diuretic use, low baseline sodium, and low body mass index. Treatment options include fluid restriction, normal saline, diuretics, hypertonic saline, and discontinuing the SSRI. The authors conclude that elderly patients receiving escitalopram or other SSRIs should be monitored carefully for SIADH in the first couple of weeks of treatment and with dose increases, especially if other risk factors are present.

Hypertension in dogs during antidiuretic hormone and hypotonic saline infusion

1979 ◽  
Vol 236 (2) ◽  
pp. H314-H322 ◽  
Author(s):  
R. D. Manning ◽  
A. C. Guyton ◽  
T. G. Coleman ◽  
R. E. McCaa
Keyword(s):  
Arterial Pressure ◽  
Antidiuretic Hormone ◽  
Plasma Renin ◽  
Sodium Concentration ◽  
Saline Infusion ◽  
Plasma Sodium ◽  
Experimental Hypertension ◽  
Plasma Aldosterone Concentration ◽  
Plasma Sodium Concentration ◽  
Hypotonic Saline

Experimental hypertension was produced in 7 dogs by continuously infusing suppressor amounts of antidiuretic hormone (ADH) and hypotonic saline after renal mass had been surgically reduced to 30% of normal. Data were collected during 9 days of control measurements, 14 days of ADH and saline infusion, and then 3 days of saline infusion to 1) determine the chronic effects of ADH on arterial pressure and 2) determine whether hypertension could be maintained during hyponatremia. During the period of ADH infusion, arterial pressure increased to hypertensive levels while plasma sodium concentration decreased almost 20 meq/1. Also, during the ADH infusion period, the dogs demonstrated decreases in heart rate, plasm potassium concentration, plasma renin activity, and plasma aldosterone concentration. Fluid volume expansion was evidenced by sustained increases in blood volume and sodium space. We conclude that when renal function is compromised, subpressor amounts of ADH can contribute to the development of hypertension, probably due to its fluid-retaining properties and in spite of the attendant hyponatremia.

Hyponatremia with Venlafaxine

1998 ◽  
Vol 32 (1) ◽  
pp. 49-51 ◽  
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.

SIADH and Hyponatremia with Theophylline

2002 ◽  
Vol 36 (7-8) ◽  
pp. 1180-1182 ◽  
Author(s):  
Evagelos N Liberopoulos ◽  
George H Alexandridis ◽  
Dimitris S Christidis ◽  
Moses S Elisaf
Keyword(s):  
Antidiuretic Hormone ◽  
Serum Sodium ◽  
Underlying Mechanism ◽  
Urinary Sodium ◽  
Case Summary ◽  
Possible Cause ◽  
Stimulation Of

OBJECTIVE: To report a case of possible theophylline-induced hyponatremia due to the syndrome of inappropriate antidiuretic hormone (SIADH). CASE SUMMARY: An 88-year-old man developed severe symptomatic hyponatremia (serum sodium 112 mEq/L) associated with inappropriate natriuresis (urinary sodium 58 mEq/L) temporally related to the initiation of theophylline. The patient fulfilled the criteria for the diagnosis of SIADH after all other causes of hyponatremia were excluded. Furthermore, no other drugs or conditions that could have evoked SIADH were found. DISCUSSION: Theophylline has rarely been associated with hyponatremia. A thiazide-like action of the drug on the stimulation of SIADH could be the underlying mechanism for SIADH. CONCLUSIONS: Theophylline should be considered as a possible cause of hyponatremia.

scholarly journals Analysis of antidepressant prescribing tendencies in Lithuania in 2003–2004

Medicina ◽  
2007 ◽  
Vol 43 (5) ◽  
pp. 412
Author(s):  
Mantas Jakimavičius ◽  
Audrius Sveikata ◽  
Paulius Vainauskas ◽  
Rimas Jankūnas ◽  
Loreta Mikučionytė ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Developed Countries ◽  
Serotonin Reuptake Inhibitors ◽  
Prescribing Patterns ◽  
Selective Serotonin ◽  
Duration Of Treatment ◽  
Defined Daily Doses ◽  
Antidepressant Use

Depression is one of the leading causes of disability worldwide, affecting 121 million people in whole world. In many developed countries, the number of prescriptions for antidepressants increased steeply during the 1990s. The objective of the present study was to evaluate the antidepressant prescribing patterns in all regions of Lithuania during 2003–2004, to analyze the use within different antidepressant groups, and to examine trends in age- and gender-specific antidepressant use. Antidepressants were classified into three groups according to Anatomic Therapeutic Chemical (ATC) Classification specifying the defined daily doses. The results of our study show an increase in the use of reimbursed antidepressants except tricyclic in 2004 when compared to 2003. Increase in the use of selective serotonin reuptake inhibitors and other nontricyclic antidepressants is probably related to their better tolerability, improved risk-benefit ratio, and less toxicity in overdose. There was no increase in the percentage of consumed selective serotonin reuptake inhibitors in elderly patients when compared with younger ones, despite elderly patients are most likely to benefit from reduced sedation, less antimuscarinic and less cardiac toxicity of selective serotonin reuptake inhibitors. The prevalence of the antidepressant use is the highest among middle-aged people (40–59 years), while the young (under 20) and elderly (older than 70) patients receive mostly selective serotonin reuptake inhibitors. Additional studies should be carried out in order to assess drug-prescribing patterns in accordance with the guidelines of depression treatment in Lithuania considering diagnosis, dosage, and duration of treatment.

scholarly journals Glycine Absorption from Irrigation Fluid during Endoscopic Resection of Rectal Tumours

1992 ◽  
Vol 29 (6) ◽  
pp. 671-673 ◽  
Author(s):  
M J Ball ◽  
P J Clarke ◽  
M G W Kettlewell
Keyword(s):  
Elderly Patients ◽  
Endoscopic Resection ◽  
Surgical Complications ◽  
Rectal Wall ◽  
Sodium Concentration ◽  
Significant Rise ◽  
Plasma Sodium ◽  
Transanal Resection ◽  
Glycine Concentration ◽  
Plasma Sodium Concentration

A significant rise in plasma glycine concentration was observed in nine elderly patients undergoing endoscopic transanal resection of rectal tumours using glycine solution for irrigation. Despite the obvious absorption of glycine, plasma sodium concentration and osmolality were not significantly altered, except in a patient whose rectal wall was perforated. In this case plasma sodium and osmolality fell, and the patient developed hyperammonaemia. Potentially adverse metabolic consequences may occur when there are surgical complications, but in the absence of such problems the absorption of glycine appears to cause little effect.

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