Reactions 1472, p13 - 5 Oct 2013

SCitalopram

Syndrome of inappropriate antidiuretic hormonesecretion in an elderly patient: case report

A 77-year-old woman developed syndrome of inappropriateantidiuretic hormone secretion while receiving citalopram fordepression.

The woman presented with confusion and unsteadiness10 days after starting citalopram [dosage and route not stated].She had a history of end-stage renal disease of unknown cause,and had undergone renal transplantation in 1985. She also hada previous history of transient mild hyponatraemia afterstarting hydrochlorothiazide, which had resolved after drugwithdrawal, 18 months before presentation. Uponexamination, she was confused and disoriented. Tests showedsevere hyponatraemia, with a serum sodium level of104 mmol/L, a serum osmolality of 227 mmol/L, aninappropriately concentrated urine with an osmolality of341 mmol/L and a urine sodium level of 30 mmol/L. She wasdiagnosed with syndrome of inappropriate antidiuretichormone secretion.

Citalopram was withdrawn, and fluid restriction wasinstituted. The woman was transferred to a high dependencyunit, and received hypertonic sodium chloride via a centralvenous catheter. Forty-eight hours later, her serum sodiumincreased to 123 mmol/L, and she was transferred to a renalward, where she began receiving sodium tablets. Over thenext 8–10 days, her serum sodium slowly rose to 130 mmol/L.Her confusion resolved over several days.

Author comment: "This case illustrates a known butuncommon potential serious adverse effect of [the]commonly used SSRI antidepressant citalopram."Sran H, et al. Confusion after starting citalopram in a renal transplant patient. BMJCase Reports 2013: [2 pages], 9 Jul 2013. Available from: URL: http://dx.doi.org/10.1136/bcr-2013-010511 - United Kingdom 803093521

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Reactions 5 Oct 2013 No. 14720114-9954/13/1472-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved