Arinzon Zeev H, Lehman Yehoshua A, Fidelman Zeev G, Krasnyansky Irina I
Department of Internal Medicine, Frieda Schiff Warburg Geriatric Medical Center, Ministry of Health, Dora, Netanya, Israel.
Ann Pharmacother. 2002 Jul-Aug;36(7-8):1175-7. doi: 10.1345/aph.1A337.
Depression is a common problem in elderly patients and is frequently treated with selective serotonin-reuptake inhibitors (SSRIs).
To report a case of delayed recurrent hyponatremia after switching from one SSRI to another.
An 87-year-old depressed woman began treatment with fluvoxamine. One week later, she was diagnosed with hyponatremia, most likely syndrome of inadequate antidiuretic hormone. Following discontinuation of fluvoxamine, the serum sodium concentration normalized. Later, she began treatment with paroxetine. Sixteen months after initiating paroxetine, she developed symptomatic recurrent hyponatremia. After paroxetine was discontinued, the sodium concentration normalized.
In this case, unlike those previously reported, hyponatremia recurred 16 months after a different SSRI was initiated. The Naranjo probability scale indicates a probable relationship between recurrent hyponatremia and paroxetine. The mechanism of SSRI-induced hyponatremia is multifactorial.
This case illustrates that replacement of one SSRI with another can cause delayed, recurrent hyponatremia in elderly patients. Plasma sodium concentrations must be monitored, not only in the first weeks of treatment, but throughout the full course.
抑郁症在老年患者中是一个常见问题，且常使用选择性5-羟色胺再摄取抑制剂（SSRI）进行治疗。
报告1例从一种SSRI换用另一种SSRI后出现迟发性复发性低钠血症的病例。
一名87岁的抑郁症女性开始使用氟伏沙明治疗。一周后，她被诊断为低钠血症，最有可能是抗利尿激素分泌不足综合征。停用氟伏沙明后，血清钠浓度恢复正常。后来，她开始使用帕罗西汀治疗。开始使用帕罗西汀16个月后，她出现了有症状的复发性低钠血症。停用帕罗西汀后，钠浓度恢复正常。
在本病例中，与之前报道的病例不同，在换用另一种不同的SSRI 16个月后出现了低钠血症复发。纳伦霍概率量表表明复发性低钠血症与帕罗西汀之间可能存在关联。SSRI诱发低钠血症的机制是多因素的。
本病例表明，在老年患者中，从一种SSRI换用另一种SSRI可导致迟发性、复发性低钠血症。不仅在治疗的最初几周，而且在整个疗程中都必须监测血浆钠浓度。
