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Syndrome of inappropriate antidiuretic hormone: case report An 88-year-old woman experienced syndrome of inappropriate antidiuretic hormone (SIADH) during treatment with citalopram for depression and naproxen for pain. The woman, who had history of depression, hypertension and osteoarthritis of the bilateral shoulders and knees, presented to hospital with generalised body ache. She reported experiencing decreased appetite, nausea and malaise for four days. She stated that she had been taking paracetamol [acetaminophen] for osteoarthritis for over five years, without relief. Hence, two weeks prior to the presentation, paracetamol was replaced with naproxen. Her home medications included amlodipine, losartan, citalopram 20mg daily and naproxen 250mg every 8h as required [routes not stated]. She stated that she had been taking the naproxen 8h every day for the previous 2 weeks. Her vital signs on admission were as follows: BP 169/82mm Hg, RR 16 breaths/minute, HR 82 beats/minute and temperature 37.3°C. Examination revealed that she was awake, alert and oriented. She was euvolemic; she did not exhibit ascites or peripheral oedema. No signs of heart failure, liver failure, goitre, brittle hair, excessively dry skin or other physical findings consistent with hypothyroidism were noted. Laboratory analyses revealed the following: fasting early morning cortisol level 18 µ/dL, proBNP 221 pg/mL, creatinine 0.47 mg/dL, thyroid-stimulating hormone 3.5 mU/L, normal hepatic panel with serum albumin 4 g/dL, cholesterol 192 mg/dL and triglyceride 44 mg/dL. Serum sodium on admission was 113 mmol/L, with urine sodium being 120 mmol/L and urine osmolality being 487 mOsm/kg. Her sodium level 10 months earlier had been 129 mmol/L. Based on these findings, SIADH was considered [not all times to reactions onsets clearly stated]. Hence, citalopram and naproxen were discontinued, and the woman’s fluid intake was restricted to 1L per day. However, on day 3, her serum sodium level continued to be 113 mg/dL, and she experienced worsening mental status. She became drowsy. She was unable to follow commands. Hence, she started receiving sodium chloride tablets, and more aggressive fluid restriction to 0.5 L/day. Thereafter, her sodium levels gradually improved, accompanied by improving mental status. Sodium chloride tablets were discontinued on day 10 of admission, at which time, her serum sodium level was 131 mmol/L. She was discharged on day 14. Her discharge medications comprised amlodipine, losartan and meloxicam for pain control. The need for antidepressants was assessed; she denied any depressive symptoms and was cleared by the psychiatry team. She was instructed to limit her fluid intake to 1 L/day. During follow-up on day 30, her serum sodium levels improved to 137 mmol/L. She reported no further complaints of decreased appetite, nausea or malaise and stated that her pain shoulder was improving. Chiu C-Y, et al. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Induced by Long-Term Use of Citalopram and Short-Term Use of Naproxe