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Severe symptomatic hyponatremia during citalopram therapy--a case report
Guillermo Flores1, Santiago Perez-Patrigeon, Carolina Cobos-Ayala
1Department of Internal Medicine, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico. gmf368@yahoo.com
BMC Nephrology
|January 20, 2004
Summary
Selective serotonin reuptake inhibitors (SSRIs) can cause hyponatremia, a dangerous drop in sodium levels. Elderly patients on citalopram require close monitoring of serum sodium to prevent this serious complication.
Area of Science:
- Neuroscience
- Endocrinology
- Pharmacology
Background:
- Hyponatremia is an uncommon complication of selective serotonin reuptuptake inhibitors (SSRIs).
- The risk is highest in the initial weeks of SSRI treatment, particularly in elderly females and those with lower body weight.
Observation:
- A 61-year-old male diabetic patient developed malaise, confusion, and seizures two weeks after initiating citalopram.
- Physical examination revealed a euvolemic state with no evidence of other contributing diseases.
- Laboratory findings included hyponatremia, serum hypoosmolality, and urine hyperosmolarity, confirming the syndrome of inappropriate antidiuretic hormone secretion.
Findings:
- Discontinuation of citalopram and fluid restriction led to an increase in serum sodium from 124 mmol/L to 134 mmol/L.
- The patient remained seizure-free and symptom-free two weeks post-discharge with normalized serum sodium levels (135 mmol/L).
Implications:
- Increased awareness of SSRI-induced hyponatremia is crucial due to the rising popularity of these antidepressants among the elderly.
- Close monitoring of serum sodium levels in elderly patients during citalopram treatment is recommended to prevent severe complications.