Hyponatremia induced by stable high dose risperidone in bipolar disorder: A case report

Year 2018, , 100 - 102, 10.06.2018

N.A. Uvais , T.P. Mohammed

https://doi.org/10.25000/acem.398477

Abstract

Risperidone is a commonly prescribed
atypical antipsychotic. Hyponatremia has been reported rarely as an adverse
effect of risperidone. We report a case of a patient with bipolar affective
disorder, who developed the syndrome of inappropriate antidiuretic hormone
secretion, probably induced by high dose risperidone. A 60-year-old male with
bipolar affective disorder, who was on risperidone 6 mg per day and sodium
valproate 1200 mg per day, developed lethargy, unsteady gait, disorientation
for the past 4 days followed by fever and productive cough with yellow sputum.
Laboratory screening revealed that the serum sodium level was 117 mol/L, the
urine sodium concentration was 106 mmol/L and plasma
osmolarity was 260.57 mmol/Kg. A
diagnosis of the syndrome of inappropriate antidiuretic hormone
secretion was made. Risperidone was thought of as a
precipitating agent and changed over to olanzapine resulting in improvement in
hyponatremia. In this patient, high-dose risperidone treatment was the most
probable cause, and the mechanisms may be related to risperidone's high
affinity for the 5-hydroxytryptamine 2A and dopamine 2 receptors.

Keywords

risperidone, high-dose, syndrome of inappropriate antidiuretic hormone secretion, bipolar affective disorder

Bipolar bozuklukta stabil yüksek doz risperidon sonrası oluşan hiponatremi: Bir olgu sunumu

Abstract

Risperidon genellikle kullanılan bir atipik antipsikotiktir.
Hiponatremi nadiren risperidonun bir yan etkisi olarak bildirilmiştir. Bipolar
affektif bozukluğu olan, uygunsuz antidiüretik hormon salınımı sendromu
gelişen, muhtemelen yüksek doz risperidonun neden olduğu bir hastayı sunuyoruz.
Bipolar duygulanım bozukluğu olan ve günde 6 mg risperidon ve günde 1200 mg
sodyum valproat kullanan 60 yaşındaki bir erkek hastada letarji, dengesiz
yürüme, son 4 gün boyunca yönelim bozukluğu, ardından ateş ve sarı balgamla karakterize
öksürük gelişti. Laboratuvar taraması sonucunda serum sodyum seviyesi 117
mmol/L, idrar sodyum konsantrasyonu 106 mmol/L idi ve plazma ozmolaritesi
260.57 mmol/Kg olarak hesaplandı. Uygunsuz antidiüretik hormon salınımı
sendromu olarak değerlendirildi. Risperidonun çökeltici bir madde olduğu
düşünülmüş ve tedavisi olanzapine değiştirilerek hiponatremisi düzeltilmiştir.
Bu hastada yüksek doz risperidon tedavisi en muhtemel neden olup, oluşum
mekanizması risperidonun 5-hidroksitriptamin 2A ve dopamin 2 reseptörlerine
yüksek afinitesi ile ilişkili olabilir.

Keywords

risperidon, yüksek doz, uygunsuz antidiüretik hormon salınımı sendromu, bipolar affektif bozukluk

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