Department of Psychiatry, NYU Langone Hospital-Long Island, NY, United States of America; Psychiatry and Medicine, NYULI - SOM, NY, United States of America.
University of California at Davis, CA, United States of America.
J Psychosom Res. 2021 Dec;151:110654. doi: 10.1016/j.jpsychores.2021.110654. Epub 2021 Oct 28.
Hyponatremia is the most common electrolyte imbalance encountered in clinical practice and is associated with negative healthcare outcomes and cost. SIADH is thought to account for one third of all hyponatremia cases and is typically an insidious process. Psychotropic medications are commonly implicated in the etiology of drug induced SIADH. There is limited guidance for clinicians on management of psychotropic-induced SIADH.
After an extensive review of the existing literature, clinical-educators from the Association of Medicine and Psychiatry developed expert consensus recommendations for management of psychotropic-induced SIADH. A risk score was proposed based on risk factors for SIADH to guide clinical decision-making.
SSRIs, SNRIs, antipsychotics, carbamazepine, and oxcarbazepine have moderate to high level of evidence demonstrating their association with SIADH. Evaluation for an avoidance of medications that cause hyponatremia is particularly important. Substitution with medication that is less likely to cause SIADH should be considered when appropriate. We propose an algorithmic approach to monitoring hyponatremia with SIADH and corresponding treatment depending on symptom severity.
The proposed algorithm can help clinicians in determining whether psychotropic medication should be stopped, reduced or substituted where SIADH is suspected with recommendations for sodium (Na+) monitoring. These recommendations preserve a role for clinical judgment in the management of hyponatremia with consideration of the risks and benefits, which may be particularly relevant for complex patients that present with medical and psychiatric comorbidities. Further studies are needed to determine whether baseline and serial Na+ monitoring reduces morbidity and mortality.
低钠血症是临床实践中最常见的电解质失衡，与不良的医疗结果和成本有关。抗利尿激素分泌不当综合征（SIADH）被认为占所有低钠血症病例的三分之一，通常是一个隐匿的过程。精神药物常与药物引起的 SIADH 的病因有关。目前，对于精神药物引起的 SIADH 的管理，临床医生可获得的指导有限。
在对现有文献进行广泛回顾后，医学与精神病学协会的临床教育工作者制定了精神药物引起的 SIADH 管理专家共识建议。根据 SIADH 的危险因素提出了风险评分，以指导临床决策。
SSRIs、SNRIs、抗精神病药、卡马西平和奥卡西平具有中等至高水平的证据表明它们与 SIADH 相关。评估避免导致低钠血症的药物尤为重要。在适当的情况下，应考虑用不太可能引起 SIADH 的药物替代。我们提出了一种监测伴有 SIADH 的低钠血症的算法方法，以及根据症状严重程度进行相应的治疗。
所提出的算法可以帮助临床医生确定是否应停止、减少或替换可疑为 SIADH 的精神药物，并提出了钠（Na+）监测建议。这些建议在考虑风险和收益的情况下，为伴有医学和精神共病的复杂患者的低钠血症管理保留了临床判断的作用。需要进一步的研究来确定基线和连续 Na+监测是否可以降低发病率和死亡率。
