SSRIs and Hyponatremia

[zenman]

---

Members do not see this ad.

Anyone see this often? Or with Cymbalta?

 

[Fastball32]

Never with sole SSRI use, I've seen it a few times with anticonvulsants.
However it is possible, but rare. I've seen priapism with trazodone, serotonin syndrome, SSRI induced mania, and lots of other side effects.
I would worry more about fluid intake rather than SSRI causing hyponatremia

 

[nitemagi]

I've seen it maybe a half-dozen times. Of course if you don't look for it, you won't find it.

 

[kugel]

I've known a few cases where SSRI was suspected to be the culprit in hyponatremia, but other meds were more likely.

It seems to me that psych meds are often presumed the be culprit in cases of significant side effects, and non-psych meds are not even investigated. My guess is that internists are so comfortable with their usual meds that they presume those couldn't be causing the problem, and the psych meds seem like Black Magic and so are the automatic suspects.

Any body else see this pattern?

One example:
Pt with depression history admitted to psych for acute onset of strange thoughts/behavior. No specific hallucinations/delusions or SI, but often failing to make any sense.
Few hours later, VS check shows severe hypotension with weakness/dizziness, and sent to ICU. Intern looks at admit orders and notices order for quetiapine, and recognizes that it is known to cause hypotension. Initial ICU H&P shows assessment lists "Hypotension due to quetiapine." Upon d/c, medical records clerk reads H&P and lists the episode as a serious "adverse event" to medication, prompting a required report from Psychiatry to the Medical Executive Committee explaining how this adverse event will be prevented in the future. Chart review shows order for "quetiapine 25mg PO q HS". Tiny dose of quetiapine, AND it was never given. The MAR proves the event occurred before the patient got ANY medications on the psych ward.

 

[nitemagi]

I've known a few cases where SSRI was suspected to be the culprit in hyponatremia, but other meds were more likely.

It seems to me that psych meds are often presumed the be culprit in cases of significant side effects, and non-psych meds are not even investigated. My guess is that internists are so comfortable with their usual meds that they presume those couldn't be causing the problem, and the psych meds seem like Black Magic and so are the automatic suspects.

Any body else see this pattern?

One example:
Pt with depression history admitted to psych for acute onset of strange thoughts/behavior. No specific hallucinations/delusions or SI, but often failing to make any sense.
Few hours later, VS check shows severe hypotension with weakness/dizziness, and sent to ICU. Intern looks at admit orders and notices order for quetiapine, and recognizes that it is known to cause hypotension. Initial ICU H&P shows assessment lists "Hypotension due to quetiapine." Upon d/c, medical records clerk reads H&P and lists the episode as a serious "adverse event" to medication, prompting a required report from Psychiatry to the Medical Executive Committee explaining how this adverse event will be prevented in the future. Chart review shows order for "quetiapine 25mg PO q HS". Tiny dose of quetiapine, AND it was never given. The MAR proves the event occurred before the patient got ANY medications on the psych ward.

Similar to the stigma of mental illness, it's often the easy scapegoat. Had a patient obtunded from an overdose, and a lazy ER resident tried explaining to me she thought it was due to the "primary psychiatric condition." I just scoffed.