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

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

Öz

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.

Anahtar Kelimeler

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

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