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.

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.

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.

scholarly journals Clinico-Biochemical Study of the Safety and Tolerability of Selective Serotonin Reuptake Inhibitors (SSRI) with Special Reference to SSRI Induced Hyponatremia in Humans and Animals

2021 ◽  
Author(s):  
Suhena Sarkar ◽  
Uttam Kumar Roy ◽  
Supreeti Biswas ◽  
Asim Kumar Mallick ◽  
Purnendu Mandal
Keyword(s):  
Serum Sodium ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Sodium Level ◽  
Group Analysis ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
P Value ◽  
Bivariate Correlation ◽  
Significant Difference

Introduction: Selective Serotonin Reuptake Inhibitors (SSRIs) are recommended as first-line anti-depressants in Major Depressive Disorder (MDD) because of their relatively benign safety profile. Hyponatremia is under reported and notorious adverse effect of SSRIs shown by few Randomised Clinical Trials (RCTs). There are only few published studies of SSRIs on serum sodium level in human and animal model. Aim: To determine SSRI induced hyponatremia in human and its correlation with age. Materials and Methods: The clinical part is a prospective cohort study whereas second part is experimental study involving animals. In clinical part-Patients of either sex, aged above 18 years, attending the Out-Patient Department (OPD) of Psychiatry of a tertiary hospital and diagnosed as MDD Diagnostic and Statistical Manual (DSM) V with the help of a senior psychiatrist, were screened and recruited in the study after satisfying the inclusion and exclusion criteria by consecutive sampling. Patients were prescribed fluoxetine (n=90), sertraline (n=55), paroxetine (n=30) and escitalopram (n=25). Parameters recorded (serum sodium) at baseline, 4th week, 8th week and 12th week. Symptoms due to hyponatremia and Adverse Drug Reactions (ADR) were also checked. Multiple group comparison at different visits for sodium level was done using one-way ANOVA and repeated measures ANOVA test and relationship of blood sodium level with age were estimated with bivariate correlation. Animal experiment was done in Pharmacology Department, animals were randomised into 5 groups control, fluoxetine, sertraline, paroxetine and escitalopram (n=6). Blood sodium checked at baseline, 2nd week and 4th week. Kruskal Wallis test and Friedman’s test done to detect changes in sodium level in follow-up period. Results: Mean age ranged between 40-50 years with equal gender distribution. Both within group and between group analysis revealed significant difference in blood sodium level (p-value< 0.0001). Hyponatremia was strongly correlated with age (correlation coefficient >-0.783). Most participants (184 out of 200) developed asymptomatic hyponatremia. Two among sertraline developed seizure leading to discontinuation to therapy. About 72 (38.09%) ADRs belonged to probable, mostly belonging to fluoxetine and sertraline group, developement of hyponatremia was 9 days (median) from starting SSRI. In animal part within group analysis revealed significant change of sodium from baseline in all drug treated animals (p-value<0.0001). Conclusion: SSRI is associated with hyponatremia and is common in elderly patients. Monitoring of serum sodium is necessary for patients on SSRI.

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