Fluoksetin Tedavisine Bağlı Gelişen Ciddi Semptomatik Hiponatremi

Öz

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.

Anahtar Kelimeler

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

Serious Symptomatic Hyponatremia Due to Fluoxetine Treatment

Öz

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.

Anahtar Kelimeler

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

Kaynakça

1. 1. Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med. 2006; 119 (1): 30-35.
2. 2. Hoorn EJ, Lindemans J, Zietse R. Development of severe hyponatraemia in hospitalized patients. Treatment-related risk factors and inadequate management. Nephrol Dial Transplant. 2006; 21: 70-76.
3. 3. Anderson RJ, Chung HM, Kluge R, Schrier RW. Hyponatremia: A prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med. 1985; 102: 164-168.
4. 4. Yıldız G, Kayataş M, Candan F. Hiponatremi; Güncel Tanı ve Tedavisi. Turk Neph Dial Transpl. 2011; 20 (2): 115–131.
5. 5. Akbaş T, vd. Selektif Serotonin Gerialım İnhibitörü (SSRİ) Kullanan Hastada Hiponatremi. Turkish journal of internal medicine. 2007;7(4):458-463.
6. 6. Rose BD, Post TW, editors. Regülation of acide-base balance. Clinical physiology of acid-base and electrolyte disorders. 5th ed New York. McGraw-Hill 2001; 703.
7. 7. Çelik MM, Karakuş A, Yengil E. Uygunsuz Antidiüretik Hormon Salınımı Sendromu. İç Hastalıkları Dergisi. 2012;19:145 -151.
8. 8. Roxanas M, Hibbert E, Field M. Venlafaxine hypo-natraemia: incidence, mechanism and manage-ment. Aust N Z J Psychiatry. 2007; 41(5):411-418.

9. 9. Jung YE, Jun TY, Kim KS, Bahk WM. Hyponatremia associated with selective serotonin reuptake inhibitors, mirtazapine, and venlafaxine in Korean patients with major depressive disorder. Int J Clin Pharmacol Ther. 2011; 49(7):437-443.
10. 10. Mogi T, Yoshino A, Ikemoto G, Nomura S. Mirtaza-pine as an alternative for selective-serotonin-reup-take-inhibitorinduced syndrome of inappropriate secretion of antidiuretic hormone. Psychiatry Clin Neurosci. 2012; 66(1):80.
11. 11. Koelkebeck K, Domschke K, Zwanzger P, Hetzel G, Lang D, Arolt V. A case of non- SIADH-induced hyponatremia in depression after treatment with reboxetine. World J Biol Psychiatry. 2009; 10(4Pt2):609-611.
12. 12. Kate N, Grover S, Kumar S, Modi M. Bupropion-induced hyponatremia. Gen Hosp Psychiatry. 2013; 35(6):681.e11-12.
13. 13. Safdieh JE, Rudominer R. A case of hyponatremia induced by duloxetine. J Clin Psychopharma-col. 2006; 26(6):675-676.
14. 14. De Picker L, Van Den Eed F, Dumont G, Moorkens G, Sabbe BG. Antidepressants and the risk of hyponatremia. a class-by-class review of literature. Psychosomatics. 2014; 55(6), 536-547.
15. 15. Doğan O. Antidepresanların neden olduğu hiponatremi. Anadolu Psikiyatri Dergisi, 2015; 16(2): 76.
16. 16. Luckey AE, Parsa CJ. Fluid and electrolytes in the aged. Arch Surg. 2003;138:1055-1060
17. 17. Kugler JP, Hustead T. Hyponatremia and hypernatremia in the elderly. Am Fam Physician. 2000;61:3623-3630.
18. 18. Liamis G, Milionis H, Elisaf M. A review of drug-induced hyponatremia. Am J Kid Dis. 2008; 52(1):144–1533.
19. 19. Liu BA, Mittmann N, Knowles SR, Shear NH. Hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone associated with the use of selective serotonin reuptake inhibitors: A review of spontaneous reports. Can Med Assoc J. 1996;155:519-27.
20. 20. Wilkinson TJ, Begg EJ, Winter AC, Sainsbury R. Incidence and risk factors for hyponatraemia following treatment with fluoxetine or paroxetine in elderly people. Br J Clin Pharmacol. 1999;47:211-7.
21. 21. Inaguma D, Kitagawa W, Hayashi H, Kanoh T, Kurata K, Kumon S. Three cases of severe hyponatreamia under taking selective seretonin reuptake inhibitor (SSRI). Nippon Jinzo Gakkai Shi. 2000;42:644-8.
22. 22. Turgutalp K, Ozhan O, Oguz EG, Horoz M, Camsari A, Yilmaz A, Kiykim A, Arici M. Clinical features, outcome and cost of hyponatremia associated admission and hospitalization in elderly and very elderly patients: A single-center experience in Turkey. Int Urol Nephrol. 2013;45:265-273.
23. 23. Rodenburg EM, Hoorn EJ, Ruiter R, Lous JJ, Hofman A, Uitterlinden AG, Stricker BH, VisserLE. Thiazide-associated hyponatremia: A population-based study. Am J Kidney Dis. 2013;62(1):67-72.
24. 24. Sharabi Y, Illan R, Kamari Y, Cohen H, Nadler M, Messerli FH, Grossman E. Diuretic induced hyponatraemia in elderly hypertensive women. J Hum Hypertens. 2002;16(9):631-635
25. 25. Bardak S, Turgutalp K, Demir S, Kıykım A. Güncel Gelişmeler Işığında Hiponatremi ve Yönetimi. Turk Neph Dial Transpl. 2015; 24 (2): 148-157.
26. 26. Wilkinson TJ, Begg EJ, Winter AC, Sainsbury R. Incidence and risk factors for hyponatraemia following treatment with fluoxetine or paroxetine in elderly people. Br J Clin Pharmacol. 1999;47:211-7.