Fluoksetin Tedavisine Bağlı Gelişen Ciddi Semptomatik Hiponatremi

Year 2020, Volume: 3 Issue: 2, 103 - 108, 01.07.2020

Mehtap Şahin

Abstract

Depresyon tedavisinde ilk olarak akla gelen ve masum olduğu düşünülen “Seçici Serotonin
Gerialım İnhibitörleri”nin (SSRİ) kullanımı sonucu ortaya çıkan hiponatremi; ciddi morbidite
ve mortaliteye neden olabilmektedir. Depresyon tanısı ile fluoksetin tedavisi başlandıktan bir
hafta sonra bulantı, kusma ve şuur değişikliği şikâyetleri ile acil servise başvuran 77 yaşındaki
kadın hasta hiponatremi tespit edilmesi üzerine dâhiliye servisinde takip edilmeye başlandı.
Hastanın kullanmakta olduğu ilaçları kesilerek sık elektrolit takibi ile destek tedavisi başlandı.
Hipertansiyon dışında sistemik hastalık öyküsü bulunmayan, ilaç kesilmesi ve elektrolit
replasmanına rağmen sodyum değeri yeterince yükselmeyen hastada oluşan hiponatreminin
sebepleri ayrıntılı olarak araştırıldı. Hastada SSRİ grubundan olan fluoksetine bağlı uygunsuz
antidiüretik hormon salınımı sendromu (UAHSS) düşünülerek sıvı kısıtlanması uygulandı.
Sonuç olarak hastanın gerek klinik ve gerekse laboratuvar bulgularında ciddi düzelme
saptandıktan sonra, psikiyatri poliklinik kontrolüne gelmek üzere taburcu edildi. SSRİ tedavisi
başlanan hastalarda; tedaviye başlanmadan önce mutlaka eşlik eden hastalıklar göz önünde
bulundurulmalı, olası yan etkiler açısından dikkatli olunmalıdır.

Keywords

Hiponatremi, Seçici serotonin gerialım inhibitörleri, Uygunsuz antidiüretik hormon salınımı sendromu

Serious Symptomatic Hyponatremia Due to Fluoxetine Treatment

Abstract

Hyponatremia, which occurs as a result of the use of selective serotonin reuptake inhibitors
(SSRI), which comes to mind first and is thought to be innocent in the treatment of depression; It
can cause serious morbidity and mortality. One week after the initiation of fluoxetine treatment
with a diagnosis of depression, a 77-year-old female patient admitted to the emergency
department with complaints of nausea, vomiting and altered consciousness, and she was
followed up in the internal medicine clinic after she had hyponatremia in the analyzes. The
medications that the patient was using were discontinued and supportive treatment was initiated
with frequent electrolyte monitoring. The causes of hyponatremia in the patient, who had no
history of systemic disease other than hypertension and whose sodium level did not increase
enough despite drug discontinuation and electrolyte replacement, were investigated in detail.
Fluid restriction was applied in the patient considering syndrome of inappropriate secretion
of antidiuretic hormone (SIADH) due to fluoxetine from the SSRI group. As a result, after a
serious improvement in both clinical and laboratory findings of the patient, she was discharged
to come to the psychiatry outpatient clinic. In patients in whom SSRI treatment is initiated; accompanying diseases should be considered before starting treatment and attention should be paid in terms
of possible side effects.

Keywords

Hyponatremia, Selective serotonin reuptake inhibitor, Syndrome of inappropriate secretion of antidiuretic hormone

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