Reactions 962 - 2 Aug 2003

SCitalopram

Hyponatraemia in an elderly patient: case reportA 74-year-old woman developed postoperative

hyponatraemia while receiving citalopram for depression.The woman had been receiving treatment with citalopram

20 mg/day [duration of therapy not stated] when sheunderwent total knee replacement surgery with subarachnoidanaesthesia and midazolam sedation. On postoperative day 1she felt nauseous and dizzy and on day 2 she became lesscommunicative and confused then unresponsive and madeuncoordinated clonic limb movements. Her pupils weredilated bilaterally and responded slowly to light, and she had aGlascow Coma Scale score of 5. She was clinically euvolaemic,well oxygenated and cardiovascularly stable. She wasventilated and transferred to the ICU, at which time she had aserum sodium level of 116 mmol/L; presurgery it had been 136mmol/L.

Over the next 2 days the woman’s fluids were restricted,citalopram was discontinued and she received empiricalantibacterial treatment. She made a full and uneventfulrecovery and, on postoperative day 4, was discharged from theICU with a serum sodium level of 130 mmol/L; this hadincreased to 134 mmol/L on postoperative day 30. Citalopramwas not recommenced.

Author comment: "We hypothesize that a combination ofrisk factors including increased age, female gender, stressresponse to surgery and citalopram therapy particularlypredisposed this patient to hyponatraemia."Holland S, et al. Citalopram - a risk factor for postoperative hyponatraemia.Anaesthesia 58: 491-492, May 2003 - England 800941431

1

Reactions 2 Aug 2003 No. 9620114-9954/10/0962-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved