Fluoksetin Tedavisine Bağlı Gelişen Ciddi Semptomatik Hiponatremi

Depresyon tedavisinde ilk olarak akla gelen ve masum olduğu düşünülen “Seçici Serotonin Gerialım İnhibitörleri”nin (SSRİ) kullanımı sonucu ortaya çıkan hiponatremi; ciddi morbidite ve mortaliteye neden olabilmektedir. Depresyon tanısı ile fluoksetin tedavisi başlandıktan bir hafta sonra bulantı, kusma ve şuur değişikliği şikâyetleri ile acil servise başvuran 77 yaşındaki kadın hasta hiponatremi tespit edilmesi üzerine dâhiliye servisinde takip edilmeye başlandı. Hastanın kullanmakta olduğu ilaçları kesilerek sık elektrolit takibi ile destek tedavisi başlandı. Hipertansiyon dışında sistemik hastalık öyküsü bulunmayan, ilaç kesilmesi ve elektrolit replasmanına rağmen sodyum değeri yeterince yükselmeyen hastada oluşan hiponatreminin sebepleri ayrıntılı olarak araştırıldı. Hastada SSRİ grubundan olan fluoksetine bağlı uygunsuz antidiüretik hormon salınımı sendromu (UAHSS) düşünülerek sıvı kısıtlanması uygulandı. Sonuç olarak hastanın gerek klinik ve gerekse laboratuvar bulgularında ciddi düzelme saptandıktan sonra, psikiyatri poliklinik kontrolüne gelmek üzere taburcu edildi. SSRİ tedavisi başlanan hastalarda; tedaviye başlanmadan önce mutlaka eşlik eden hastalıklar göz önünde bulundurulmalı, olası yan etkiler açısından dikkatli olunmalıdır.

Anahtar Kelimeler:

Hiponatremi, Seçici serotonin gerialım inhibitörleri, Uygunsuz antidiüretik hormon salınımı sendromu

Serious Symptomatic Hyponatremia Due to Fluoxetine Treatment

Hyponatremia, which occurs as a result of the use of selective serotonin reuptake inhibitors (SSRI), which comes to mind first and is thought to be innocent in the treatment of depression; It can cause serious morbidity and mortality. One week after the initiation of fluoxetine treatment with a diagnosis of depression, a 77-year-old female patient admitted to the emergency department with complaints of nausea, vomiting and altered consciousness, and she was followed up in the internal medicine clinic after she had hyponatremia in the analyzes. The medications that the patient was using were discontinued and supportive treatment was initiated with frequent electrolyte monitoring. The causes of hyponatremia in the patient, who had no history of systemic disease other than hypertension and whose sodium level did not increase enough despite drug discontinuation and electrolyte replacement, were investigated in detail. Fluid restriction was applied in the patient considering syndrome of inappropriate secretion of antidiuretic hormone (SIADH) due to fluoxetine from the SSRI group. As a result, after a serious improvement in both clinical and laboratory findings of the patient, she was discharged to come to the psychiatry outpatient clinic. In patients in whom SSRI treatment is initiated; accompanying diseases should be considered before starting treatment and attention should be paid in terms of possible side effects.

Keywords:

Hyponatremia, Selective serotonin reuptake inhibitor, Syndrome of inappropriate secretion of antidiuretic hormone,

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ISSN: 2630-5585
Başlangıç: 2018
Yayıncı: İstanbul Aydın Üniversitesi

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