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  1. bookVolume 18 (2017): Issue 2 (June 2017)
Current Problems of Psychiatry's Cover Image
Current Problems of Psychiatry
Journal Details
License
Format
Journal
eISSN
2353-8627
First Published
30 Mar 2016
Publication timeframe
4 times per year
Languages
English
access type Open Access

Hiponatremia in the practice of a psychiatrist. Part 1: SIADH syndrome and drug-induced hyponatremia.

Ewa Stelmach,
Ewa Stelmach,
Olga Hołownia,
Olga Hołownia,
Maciej Słotwiński,
Maciej Słotwiński,
Aneta Gerhant and
Aneta Gerhant and
Marcin Olajossy
Marcin Olajossy
Published Online: 01 Sep 2017
Volume & Issue: Volume 18 (2017) - Issue 2 (June 2017)
Page range: 120 - 137
Received: 02 Jan 2017
Accepted: 24 Apr 2017
Current Problems of Psychiatry's Cover Image
Current Problems of Psychiatry
Journal Details
License
Format
Journal
eISSN
2353-8627
First Published
30 Mar 2016
Publication timeframe
4 times per year
Languages
English
Abstract

Introduction. Hyponatremia is an important part of psychiatric practice. In order to analyze its causes and symptoms, the literature on hyponatremia in psychiatric patients has been reviewed. The work has been divided into two separate manuscripts. In the first one the authors discuss the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and hyponatremia occurring with the use of psychotropic drugs (antidepressants, antipsychotics, normotimics), while the second paper discusses research on psychogenic polydipsia. The causes of hyponatremia in patients treated in psychiatric wards include: water intoxication associated with polydipsia, somatic comorbidities, side effect of internal medicine and psychiatric drugs. The most common mechanism leading in these cases to hyponatremia is the syndrome of inappropriate secretion of vasopressin (SIADH). The SIADH syndrome is a group of symptoms, first described in 1967 by Schwartz and Bartter in The American Journal of Medicine, which results from the hypersecretion of antidiuretic hormone, also called vasopressin, which causes patients to develop normovolemic hyponatremia. The phenomenon of drug-induced hyponatremia in psychiatric practice is generally observed with the use of antidepressants, antipsychotics and anti-epileptic drugs (used in psychiatry as normotimic drugs).

Aim and method. The first manuscript includes a review of literature on the syndrome of inappropriate secretion of vasopressin (SIADH) and hyponatremia occurring after the use of psychotropic drugs, and is divided into two subsections: 1. The syndrome of inappropriate secretion of vasopressin (SIADH), 2. Hyponatremia and psychotropic drugs (antidepressants, antipsychotics, normotimics).

Conclusion. In the view of the reviewed literature it is extremely important to control the natremia level during pharmacotherapy using the above mentioned drugs, especially in the initial period of therapy.

Keywords

  • hyponatremia
  • SIADH syndrome
  • drug-induced hyponatremia

1. Kovesdy C.P., Significance of hypo- and hypernatremia in chronic kidney disease, Nephrol Dial Transplant 2012, 27 (3): 891-898.10.1093/ndt/gfs038Search in Google Scholar

2. Emsley J., Nature’s Building Blocks: An A-Z Guide to the Elements. Wyd. Oxford University Press 2003: 398.Search in Google Scholar

3. Kuriyan J., Konforti B., Wemmer D., The Molecules of Life. Wyd. Garland Science 2013: 485.10.1201/9780429258787Search in Google Scholar

4. Reynolds R.M., Padfield P.L., Seckl J.R., Disorders of sodium balance. BMJ. 2006 Mar 25; 332(7543): 702–705.10.1136/bmj.332.7543.702Search in Google Scholar

5. Spasovski G., Vanholder R., Allolio B., Annane D., Ball S., Bichet D., Decaux G., Fenske W., Hoorn EJ., Ichai C., Joannidis M., Soupart A., Zietse R., Haller M., van der Veer S., Van Biesen W., Nagler E., Clinical practice guideline on diagnosis and treatment of hyponatraemia, Intensive Care Med. 2014, 40: 320-331.10.1007/s00134-014-3210-2Search in Google Scholar

6. Sahay M., Sahay R., Hyponatremia: A practical approach, Indian J Endocrinol Metab. 2014 Nov-Dec, 18(6): 760–771.Search in Google Scholar

7. Ciechanowski K., Hipo- i hipernatremia- przyczyny i zasady terapii, Forum Nefrologiczne 2011. Tom 4, nr 4, 362–366 Copyright © 2011 Via Medica ISSN 1899–3338.Search in Google Scholar

8. Lum G., Severe Hyponatremia in a Schizophrenic Patient, Clinical Chemistry 2013, 59:6: 887-891.10.1373/clinchem.2012.194969Search in Google Scholar

9. Singh P., Singh A., Chawla J., Singh A., Kaur S., Singla M., Profound Hyponatremia: Prevalence, Underlying Disorders and Outcome in Tertiary Care Hospital, British Journal of Medicine & Medical Research 2016, 14(12): 1-6.10.9734/BJMMR/2016/23971Search in Google Scholar

10. Freda B.J, Nurko S., Hyponatremia and hypernatremia, Carey WD, Gordon S, eds. Cleveland Clinic: Currrent Clinical Medicine. 2nd edition. Philadelphia, PA: Elvesier Saunders 2010: 818-823.10.1016/B978-1-4160-6643-9.00126-0Search in Google Scholar

11. Maxwell A.P., Diagnosis and management of hyponatraemia: AGREEing the guidelines, Maxwell BMC Medicine 2015: 13:31.10.1186/s12916-015-0277-8Search in Google Scholar

12. Verbalis J.G., Goldsmith S.R., Greenberg A., Korzelius C., Schrier R.W., Sterns R.H., Thompson C.J., Diagnosis, evaluation, and treatment of hyponatremia: Expert Panel Recommendations, Am J Med. 2013 Oct, 126(10 Suppl 1):S1-42.Search in Google Scholar

13. Schrier R.W., Bansal S., Diagnosis and management of hyponatremia in acute illness, Curr Opin Crit Care. 2008 Dec, 14(6): 627–634.Search in Google Scholar

14. Pillai B.P., Unnikrishnan A.G., Pavithran P.V., Syndrome of inappropriate antidiuretic hormone secretion: Revisiting a classical endocrine disorder, Indian J Endocrinol Metab. 2011 Sep, 15(Suppl3): 208–215.Search in Google Scholar

15. Nguyen M.K, Ornekian V., Butch A.W., Kurtz I., A new method for determining plasma water content: application in pseudohyponatremia, American Journal of Physiology - Renal Physiology 2007, 292(5):1652-1656.10.1152/ajprenal.00493.2006Search in Google Scholar

16. Załuska M.: Diagnoza i terapia hiponatremii u pacjenta z zaburzenia-mi psychicznymi. Farmakoter. Psych. Neurol. 2005, 2: 155-166.Search in Google Scholar

17. Bartter F, Schwartz W. The syndrome of inappriopriate secretion of antidiuretic hormone. The American Journal of Medicine (1967)10.1016/0002-9343(67)90096-4Search in Google Scholar

18. Crowley RK, Thompson Cj. Syndrome of inappriopriate diuresis. Expert Rev Endocrinol Metabol (2006) 1:537-4710.1586/17446651.1.4.53730290457Search in Google Scholar

19. Cuesta M, Thompson CJ. The syndrome of inappriopriate diuresis. Best Practice and Research Clinical Endocrinology and Metabolism (2016) 175-17810.1016/j.beem.2016.02.00927156757Search in Google Scholar

20. Smith D, Moore K, et al. Downward resetting of the osmotic treshold for thirst in patients with SIADH. American Journal of Physiology – Endocrinology and metabolism (2004) 287: E1019-E102310.1152/ajpendo.00033.200415213060Search in Google Scholar

21. Adrogue H, Madias N. Hyponatremia. The New England Journal of Medicine (2000)10.1056/NEJM20000525342210710824078Search in Google Scholar

22. Cuesta, M., Garrahy, A., & Thompson, C. J. (2016). SIAD: practical recommendations for diagnosis and management. Journal of endocrinological investigation, 39(9), 991-1001.10.1007/s40618-016-0463-327094044Search in Google Scholar

23. Sherlock, M., O'sullivan, E., Agha, A., Behan, L. A., Rawluk, D., Brennan, P., ... & Thompson, C. J. (2006). The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clinical endocrinology, 64(3), 250-254.10.1111/j.1365-2265.2006.02432.x16487432Search in Google Scholar

24. Shepshelovich, D., Leibovitch, C., Klein, A., Zoldan, S., Milo, G., Shochat, T., ... & Lahav, M. (2015). The syndrome of inappropriate antidiuretic hormone secretion: distribution and characterization according to etiologies. European journal of internal medicine, 26(10), 819-824.10.1016/j.ejim.2015.10.02026563934Search in Google Scholar

25. Kirby, D., & Ames, D. (2001). Hyponatraemia and selective serotonin re-uptake inhibitors in elderly patients. International journal of geriatric psychiatry, 16(5), 484-493.10.1002/gps.36711376464Search in Google Scholar

26. Verbalis, J. G., Greenberg, A., Burst, V., Haymann, J. P., Johannsson, G., Peri, A., ... & Dave, J. (2016). Diagnosing and treating the syndrome of inappropriate antidiuretic hormone secretion. The American Journal of Medicine, 129(5), 537-e9.10.1016/j.amjmed.2015.11.00526584969Search in Google Scholar

27. Egger C, et al. A review of hyponatremia associated with SSRIs, reboxetine and venlafaxine. International Journal of Psychiatry in Clinical Practice (2006) 10(1): 17-2610.1080/1365150050041021624926764Search in Google Scholar

28. Fenoglio I, et al. Drug induced hyponatremia. About a series of 54 cases notified to the reginal Center of Pharmacovigilance of Saint-Etienne. Therapie (2011) 66 (2): 139-14810.2515/therapie/201101121635862Search in Google Scholar

29. Fonzo-Christe C, Vogt N. Susceptibilty of the elderly patient to hyponatremia induced by selective serotonin reuptake inhibitors. Therapie (2000) 55(5):597-604Search in Google Scholar

30. Brownfields Ms, et al. Neuropharmacological characterization of serotoninergic stimulation of vasopressin secretion in concious rats. Neuroendocrinology (1988) 47(4):277-8310.1159/0001249253374754Search in Google Scholar

31. Mannesse C, et al. Characteristicks, prevalence, risk factors and underlying mechanism of hyponatremia in elderly patients treated with wntidepressants: a cross-sectional study. Maturitas 76 (2013) 357-363Search in Google Scholar

32. Kirby D, et al. Hyponatremia in elderly psychiatric patients treated with selective serotonin reuptake inhibitors and venlafaxine: a retrospective controlled study in an inpatient unit. International Journal of Geriatric Psychiatry (2002) 17: 231-23710.1002/gps.59111921151Search in Google Scholar

33. Knigge U, et al. Histaminergic and catecholaminergic interactions in the central regulation of vasopressin and oxytocin secretion. Endocrinology (1999) 140(8): 3713-910.1210/endo.140.8.689110433231Search in Google Scholar

34. Letmaier M, et al. Hyponatraemia during psychopharmacological treatment: results of a drug surveillance programme. International Journal of Neuropsychopharmacology (2012) 15, 739-74810.1017/S146114571100119221777511Search in Google Scholar

35. Leth-Moller KB, Hansen AH, et al. Antidepressants and the risk of hyponatremia: a Danish register-based population study. BMJ Open (2016)10.1136/bmjopen-2016-011200487410427194321Search in Google Scholar

36. Siegel A, Forte S, et al. Drug-related hyponatremic encephalopathy: rapid clinical response averts life-threatening acute cerebral edema. American Journal of case reports (2016) 17: 150-15310.12659/AJCR.896572478752526956638Search in Google Scholar

37. Giorlando F, et al. Hyponatraemia: an audit of aged psychiatry patients taking SSRIs and SNRIs. Current Drug Safety (2013) 8(3):175-8010.2174/1574886311308999003623841535Search in Google Scholar

38. Bowen P. Use of serotonin reuptake inhibitors in the treatment of depression in older adults: identifying and managing potential risk of for hyponatremia. Geriatric Nursing (2009) 85-8910.1016/j.gerinurse.2008.04.00719345847Search in Google Scholar

39. Barclay T, et al. Citalopram-associated SIADH. The Annals of Pharmacoteraphy (2002) 36: 1558-6310.1345/aph.1C07112243606Search in Google Scholar

40. Fabian, T. J., Amico, J. A., Kroboth, P. D., Mulsant, B. H., Corey, S. E., Begley, A. E., ... & Pollock, B. G. (2004). Paroxetine-induced hyponatremia in older adults: a 12-week prospective study. Archives of Internal Medicine, 164(3), 327-332.10.1001/archinte.164.3.32714769630Search in Google Scholar

41. Arinzon Z, et al. Delayed recurrent siadh associated with ssris. The Annals of Pharmacoteraphy (2002) 36: 1175-710.1345/aph.1A33712086550Search in Google Scholar

42. Noohi S, et al. Selective serotonin re-uptake inhibitors and hyponatermia in acutely medically-ill inpatients. Current Drug Safety (2016) 11(2):121-710.2174/157488631166616022613160326916932Search in Google Scholar

43. Gandhi S., McArthur E., Reiss JP., Mamdani MM., Hackam DG., Weir MA., Garg AX. Atypical antipsychotic medications and hyponatremia in older adults: a population based cohort study. Canadian Journal of Kidney Health and Disease (2016) 3:2110.1186/s40697-016-0111-z482718427069639Search in Google Scholar

44. Whitten JR, Ruehter VL. Risperidone and hyponatremia: a case report. Ann Clin Psychiatry. 1997;9:181–310.3109/10401239709147795Search in Google Scholar

45. Atalay A, Turhan N, Aki OE. A challenging case of syndrome of inappropriate secretion of antidiuretic hormone in an elderly patient secondary to quetiapine. South Med J. 2007;100:832–310.1097/SMJ.0b013e3180f607cf17713312Search in Google Scholar

46. Bakhla AK, Guria RT, Kumar A. A suspected case of olanzapine induced hyponatremia. Indian J Pharmacol 2014;46:441-210.4103/0253-7613.135961411854225097287Search in Google Scholar

47. Dudeja SJ, McCormick M, Dudeja RK. Olanzapine induced hyponatraemia. Ulster Med J. 2010;79:104–5Search in Google Scholar

48. Bhuvaneswar CG, Baldessarini RJ, Harsh VL, Alpert JE. Adverse endocrine and metabolic effects of psychotropic drugs. CNS Drugs. 2009;23:1003–2210.2165/11530020-000000000-0000019958039Search in Google Scholar

49. Rider JM, Mauger TF, Jameson JP. Water handling in patients receiving haloperidol decanoate. Ann Pharmacother 1995; 29: 663–610.1177/106002809502907-8018520076Search in Google Scholar

50. Ananth J, Lin KM. SIADH: a serious side effect of psychotropic drugs. Int J Psychiatr Med 1987; 16: 401–710.2190/WMY8-EXKD-N442-ERDQSearch in Google Scholar

51. Correll CU., Detraux J., De Lepeleire J., De Hert M. Effects of anti-psychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry 2015;14:119–13610.1002/wps.20204Search in Google Scholar

52. Meulendijks D, Mannesse CK, Jansen PA, Van Marum RJ, Egberts TCG. Antipsychotic-induced hyponatraemia: a systematic review of the published evidence. Drug Saf. 2010;33:101–1410.2165/11319070-000000000-00000Search in Google Scholar

53. Mannesse CK, van Puijenbroek EP, Jansen PA, van Marum RJ, Souverein PC, Egberts TC. Hyponatraemia as an adverse drug reaction of antipsychotic drugs: a case-control study in VigiBase. Drug Saf. 2010 Jul 1;33(7):569-7810.2165/11532560-000000000-00000Search in Google Scholar

54. Shepshelovich D., Schechter A., Calvarysky B., Diker-Cohen T., Rozen-Zvi B., Gafter-Gvili Anat. Medication Induced SIADH: Distribution and Characterization According to Medication Class. doi: 10.1111/bcp.1325010.1111/bcp.13250Search in Google Scholar

55. Atsariyasinga W., Goldman MB. A systematic review of the ability of urine concentration to distinguish antipsychotic- from psychosis-induced hyponatremia. Psychiatry Research 217 (2014) 129–133Search in Google Scholar

56. Liamis G., Milionis H., Elisaf M., A review of drug-induced hyponatremia, Am J Kidney Dis. 2008 Jul;52(1):144-53.10.1053/j.ajkd.2008.03.004Search in Google Scholar

57. Zaremba P.D., Białek M., Błaszczyk B., Cioczek P., Czuczwar S.J., Non-epilepsy uses of antiepileptic drugs, Pharmacological Reports 2006, 58, 1-12, ISSN1734-1140.Search in Google Scholar

58. Kuz G. M., Manssourian A., Carbamazepine-Induced Hyponatremia: Assessment of Risk Factors, Ann Pharmacother. 2005 Nov; 39(11):1943-6.10.1345/aph.1G209Search in Google Scholar

59. Krysiak R., Okopień B., Hiponatremia spowodowana przez karbamazepinę, Pol Arch Med Wewn. 2007; 117 (4): 193-195.Search in Google Scholar

60. Kumar P.N., Gopalakrishnan A., Oxcarbazepine - induced hyponatremia in bipolar disorder: A report of two cases, Indian J Psychiatry. 2016 Apr-Jun; 58(2): 233–234.10.4103/0019-5545.183789Search in Google Scholar

61. Patel K.R., Meesala A., Stanilla J.K., Sodium Valproate–Induced Hyponatremia: A Case Report, Prim Care Companion J Clin Psychiatry. 2010; 12(5)10.4088/PCC.09l00941yelSearch in Google Scholar

62. Kılıç H., Ekici B., Ergul Y., Keskin S., Uysal S., Lamotrigine-induced SIADH in a child with central diabetes insipidus, J Pediatr Neurosci. 2011 Jan;6(1):89-90.Search in Google Scholar

63. Mewasingh L, Aylett S, Kirkham F, Stanhope R. Hyponatraemia associated with lamotrigine in cranial diabetes insipidus. Lancet. 2000; 356:65610.1016/S0140-6736(00)02613-1Search in Google Scholar

64. Lu X., Wang X., Hyponatremia induced by antiepileptic drugs in patients with epilepsy EXPERT OPINION ON DRUG SAFETY, 2017 VOL. 16, NO. 1, 77–87.10.1080/14740338.2017.124839927737595Search in Google Scholar

65. Dong X., Leppik I.E., White J, Rarick J., Hyponatremia from oxcarbazepine and carbamazepine, Neurology. 2005 Dec 27;65(12):1976-8.10.1212/01.wnl.0000188819.45330.9016380624Search in Google Scholar

66. Kim Y.S., Kim D.W., Jung K. H., Lee S.T., Kang B.S., Byun J.I., Yeom J.S., Chu K., Lee S.K., Frequency of and risk factors for oxcarbazepine-induced severe and symptomatic hyponatremia, Seizure Volume 23, Issue 3, Pages 167-246 (March 2014).10.1016/j.seizure.2013.11.01524378204Search in Google Scholar

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