Nakamura Masaru, Nagamine Takahiko
Dr. Nakamura is with the Department of Psychiatric Internal Medicine at Kosekai-Kusatsu Hospital in Hiroshima, Japan.
Dr. Nagamine is with the Department of Psychiatric Internal Medicine at Sunlight Brain Research Center in Yamaguchi, Japan.
Innov Clin Neurosci. 2019 Jul 1;16(7-08):32-34. eCollection 2019 Jul-Aug.
Psychotropic-induced hyponatremia is one of the most common electrolyte abnormalities observed in routine psychiatric practice. However, many features of hyponatremia mimic those seen in depression, which can lead to the condition being overlooked. Takotsubo cardiomyopathy, or apical ballooning syndrome (ABS), is a reversible cardiomyopathy that mimics acute myocardial infarction. Limited evidence has indicated that hyponatremia might have a role in the development of ABS. We present a case of female patient with bipolar disorder who developed acute hyponatremia and ABS while taking lamotrigine. After cessation of lamotrigine, a time-sequential improvement of hyponatremia and ABS was observed via repeated electrocardiogram, suggesting a relationship between hyponatremia and ABS. Due to the association between severe hyponatremia and Takotsubo cardiomyopathy, this case highlights the importance of carefully monitoring serum sodium levels and ECG changes in patients on psychotropic medications during their entire course of treatment to prevent serious or fatal complications.
精神药物所致低钠血症是常规精神科诊疗中最常见的电解质异常之一。然而，低钠血症的许多特征与抑郁症相似，这可能导致该病症被忽视。应激性心肌病，即心尖球囊样综合征（ABS），是一种可逆转的心肌病，其症状与急性心肌梗死相似。有限的证据表明，低钠血症可能在ABS的发生发展中起作用。我们报告一例双相情感障碍女性患者，在服用拉莫三嗪时出现急性低钠血症和ABS。停用拉莫三嗪后，通过重复心电图观察到低钠血症和ABS呈时间顺序性改善，提示低钠血症与ABS之间存在关联。鉴于严重低钠血症与应激性心肌病之间的关联，该病例凸显了在整个治疗过程中仔细监测服用精神药物患者的血清钠水平和心电图变化以预防严重或致命并发症的重要性。
