van den Heuvel O A, Bet P M, van Dam E W C M, Eeckhout A M
VU Medisch Centrum, MB Amsterdam.
Ned Tijdschr Geneeskd. 2006 Sep 2;150(35):1944-8.
A 45-year-old man with paranoid schizophrenia repeatedly developed hyponatraemia due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), both after treatment with haloperidol and after taking quetiapine. This side effect did not occur subsequently during clozapine treatment. SIADH has been described in connection with almost all psychotropic drugs. Since the risk of developing SIADH is increased with increasing age, comorbid somatic disorders and polypharmacy, and the mean age of the psychiatric patient will further increase in the years to come, the physician should be alert to the risk factors and the clinical symptoms of disturbances in water balance; moreover, the proper differential diagnostic deliberations should be made. In case of increased risk, it is recommended to monitor the serum sodium during the first 2-4 weeks of pharmacotherapy.
一名45岁的偏执型精神分裂症男性患者,在使用氟哌啶醇治疗后以及服用喹硫平后,因抗利尿激素分泌不当综合征(SIADH)反复出现低钠血症。而在使用氯氮平治疗期间,这种副作用并未随后发生。几乎所有精神药物都曾被描述与SIADH有关。由于随着年龄增长、合并躯体疾病以及联合用药,发生SIADH的风险会增加,并且在未来几年精神科患者的平均年龄将进一步上升,医生应警惕水代谢平衡紊乱的风险因素及临床症状;此外,应进行适当的鉴别诊断思考。在风险增加的情况下,建议在药物治疗的头2至4周监测血清钠水平。