Duloksetine Bağlı Hiponatremi

2019; 30(4): 287-289
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Duloxetine Induced Hyponatremia

Hyponatremia can be asymptomatic or have a wide range of clinical
presentations such as headaches, muscle cramps, nausea, seizures, coma,
cerebral edema and may even result in death. Despite it has been
suggested that duloxetine has a relatively less risk of hyponatraemia,
the number of case reports are increasing.
A 45- year old female patient with complaints of fear, anxiety,
sleeplessness and headache was started on duloxetine (30 mg/day). In
the first week of the treatment, she was admitted to the emergency
service with dizziness, dry mouth, polyuria and polydipsia. She had
to be transferred to the intensive care unit because of agitation, loss of
consciousness and a generalized tonic-clonic seizure. Blood levels of
Sodium (Na+), Potassium (K+) and Chlorine (Cl-) were, respectfully,
121 mmol/L, 2.7 mmol/L and 87 mmol/L. Brain imaging displayed
cerebral edema. Electrolyte levels were regulated with saline infusions.
Amitriptyline was initiated for the ongoing headache and anxiety. In
outpatient visits, hyponatremia did not recur in the following 3 months.
Low dose duloxetine was associated with severe hyponatremia signs
and symptoms in an individual who was not previously considered
as high risk for hyponatraemia. The patient’s history did not reveal
any complaints related to hyponatremia when she was treated with
sertraline two years ago. Based on these, we discussed the risk factors for
hyponatremia and risky antidepressant classes.
Key Words: Antidepressants, hyponatremia, inappropriate ADH secretion