Escitalopram
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Syndrome of inappropriate antidiuretic hormone secretion in an elderly patient: case report A 97-year-old woman developed syndrome of inappropriate antidiuretic hormone secretion (SIADH) during treatment with escitalopram for anxiety. The woman started receiving escitalopram 5 mg/day, and was admitted for a suspected vertebral fracture and hyponatraemia 1 week later. Her history was remarkable for numerous falls during the preceding 2 weeks, and increased confusion and thirst for 1 week. Her concomitant medication included furosemide. She had a BP of 165/76mm Hg, an irregular HR, and an ECG showed atrial fibrillation. Laboratory investigations showed the following: sodium 113 mmol/L, potassium 3.3 mmol/L, magnesium 0.7 mmol/L and creatinine 0.5 mg/dL. Furosemide was discontinued on admission, and the woman was treated with fluid restriction and hypertonic saline. However, her serum sodium level was still critical the following day; further investigations showed a serum osmolality of 265 mOsm/kg, a urine osmolality of 406 mOsm/kg and a urine sodium level of 121 mmol/L. SIADH was diagnosed. An escitalopram-induced reaction was suspected, and the drug was withdrawn. Her serum sodium peaked at 126 mmol/L on day 3, and then decreased. Hypertonic saline was restarted on day 5, and she was in stable condition on discharge on day 8. Author comment: "The Naranjo probability scale indicates a probable relationship between escitalopram initiation and SIADH in this patient." Koski RR, et al. Case report of SIADH associated with escitalopram use. Journal of Pharmacy Practice 22: 594-599, No. 6, Dec 2009. Available from: URL: http:// 803013921 dx.doi.org/10.1177/0897190009333359 - USA
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Reactions 15 May 2010 No. 1301
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