Carbamazepine
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Syndrome of inappropriate antidiuretic hormone secretion: case report An adolescent boy developed syndrome of inappropriate antidiuretic hormone secretion (SIADH) while receiving carbamazepine. The boy, who had mental retardation and had developed epilepsy at the age of 8 years, had started receiving carbamazepine at the age of 11 [route not stated]. At the age of 17, after the carbamazepine dose was increased from 400 to 500mg [frequency not stated], he was hospitalised twice with vomiting, dehydration and altered consciousness. On both occasions, his serum carbamazepine concentration was higher than the therapeutic range (18.7 and 19.2 µg/mL). His serum sodium level was 128 mEq/L. Carbamazepine was stopped temporarily, and the boy’s serum level normalised after receiving a drip. He was discharged, but subsequently experienced vomiting and fever. At the age of 23, he had fever, general fatigue and loss of appetite, and was hospitalised with a sodium level of 126 mEq/L. He had no appetite and refused water. A fluid replacement drip was started. Urinary sodium was 95 mmol/L. On hospital day 4, his serum sodium level was 115 mEq/L. SIADH was considered, and the amount of replenishment fluid was reduced. His carbamazepine dose was decreased from 500 to 400mg. On day 6, his carbamazepine dose was decreased to 300mg; the amount of urine exceeded the amount of replenishment fluid, and his serum sodium level increased to 130 mEq/L. His antidiuretic hormone level was 0.7 pg/mL, and SIADH was diagnosed. He received sulpiride and cyproheptadine to increase his appetite, and oral intake was started. MRI scans showed complete absence of the corpus callosum without pineal or pituitary glands, and he was diagnosed with septo-optic dysplasia. Carbamazepine was discontinued gradually and his water intake was limited. His serum sodium level increased to 135 mEq/L, and remained normal 1.5 years later. Author comment: The mechanism of SIADH in this case involves carbamazepine directly acting upon the osmoreceptors of the hypothalamus, and causing an antidiuretic hormone regulation disorder. The risk of SIADH from elevated carbamazepine serum concentration increases if there are hypothalamus or pituitary gland abnormalities. Hirayama T, et al. A male-case of non-secondary sexual characteristic septo-optic dysplasia with carbamazepine-induced syndrome of inappropriate secretion of antidiuretic hormone. [Japanese]. Journal of the Japan Epilepsy Society 28: 409-415, No. 3, Jan 2010. Available from: URL: http://dx.doi.org/10.3805/ 803068633 jjes.28.409 [Japanese; summarised from a translation] - Japan
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Reactions 31 Mar 2012 No. 1395
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