Severe hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with fluoxetine: case report

Arquivos de neuro-psiquiatria
Carlos Alexandre TwardowschyMarta Angela de Souza Brandão

Abstract

Hyponatremia is a significant complication of treatment with serotonin selective reuptake inhibitors (SSRI). We describe a case of a 53-year-old woman that was started on fluoxetine 20 mg/day for depression. Nine days later, the patient started with weakness, nausea, progressing to confusion, inappetence and vomit. Three hours later she became unresponsive and had a generalized seizure. She was brought to our emergency service. On admission, the patient was normovolemic, without focal motor deficits, but had mild generalized muscle rigidity and Babinski's sign bilaterally. Serum sodium was 105 mmol/L, serum osmolality, 220 mmol/L, and urinary osmolality, 400 mmol/L. The other laboratory exams, chest X-ray, cerebrospinal fluid and cranium tomography were normal. She was found to have fluoxetine-induced SIADH and it was discontinued. We started the hyponatremia correction and, in 5 days, the mental status of the patient gradually returned to a normal baseline, paralleling the resolution of her hyponatremia, without recurrence. Hyponatremia and SIADH should be considered if a patient experiences deterioration in his or her clinical condition while taking SSRI. The use of SSRI antidepressants should be remembered in the differentia...Continue Reading

References

May 8, 1995·Archives of Internal Medicine·E L SieglerB L Strom
Apr 6, 1999·British Journal of Clinical Pharmacology·T J WilkinsonR Sainsbury

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Citations

May 25, 2007·Current Psychiatry Reports·Brian DundasMeera Narasimhan
Sep 6, 2011·The Australian and New Zealand Journal of Psychiatry·Seetal DoddMichael Berk
Dec 19, 2009·The Consultant Pharmacist : the Journal of the American Society of Consultant Pharmacists·Rebecca StovallKimberly M Crosby
Aug 22, 2009·British Journal of Clinical Pharmacology·Sonja Kwadijk-de GijselBruno H Ch Stricker

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