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Delayed recurrent SIADH
associated with SSRIs.
Arinzon ZH, Lehman YA,
Fidelman ZG, Krasnyansky II.
Department of Internal Medicine,
Frieda Schiff Warburg Geriatric Medical Center, Ministry of Health,
Dora, Netanya, Israel. Darinzon@newmail.net
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.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 12086550 [PubMed -
indexed for MEDLINE]
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