Vol. 32, pp , 2004 SSRI 1. paroxetine 10 mg 3 ADH SIADH ADH SSRI SIADH. SSRI ADH SIADH paroxetine ADH ADH : 78 HCV SSRI SSRI SIADH

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1 577 Vol. 32, pp , 2004 SSRI C : C paroxetine 0 mg meql Na Na ADH paroxetine ADH SIADH 2 04 meql SSRI SIADH SSRI ADH SIADH paroxetine ADHSI- ADH ADH ADH Na ADH SSRI SSRI SIADH SSRI SIADH : 78 : : 2 HCV : :

2 578 ADL 0 : 36.3C mmhg turgor : 28 meql Table. : Fig. -a CT S5 A-P Fig. -b Fig. 2: 28 meql Table. Laboratory Findings on Admission Figure. a Chest X-ray film on admission showed mild cardiomegaly, thickening of pleura, and calcification in bilateral apices. b Dynamic abdominal CT on admission showed low density area and arterial-portal shunt in segment V of the liver induced by previous treatments for HCC. There was no new spaceoccupying-lesion in the liver. c Brain CT at the somnolent status showed no intra-cranial abnormality. 60

3 SSRI SIADH 579 Figure 2. Clinical course. 2 paroxetine 0 mg meql 6 BUNCr 3 meql 237 mosmkg 557 mosmkg ADH.58 pgml SIADH Table. 2 CT Fig. -c, SIADH paroxetine meql 2 4 meql 2 32 meql 2 SSRI flvo- Table 2. Laboratory Findings at the Somnolent Status xamine, paroxetine SNRI milnacipran SSRI fluoxetine Na SSRI paroxetine SIADH 6

4 SSRI SI- ADH 5-HT 2 5-HT C ADH 0 paroxetin paroxetine 23 SSRI 996 Lie SSRI ADRAC SSRI 60 2 SIADH ADH ADH 46 ADH 79 SSRI CYP2D6 20 SSRI SIADH SSRI SSRI SIADH 34 Liu BA, Mittmann N, Knowles SR, Shear NH: Hyponatremia and syndrome of inappropriate secretion of antidiuretic hormone associated with the use of reuptake inhibitors: A review of spontaneous repopriate secretion of antidiuretic hormone associated with the use of selective serotonin reupuptake inhibitors: a review of spontaneous reports: Can Med Assoc J 996; 55: ADRAC: Selective serotonin re-upuptake inhibitors and SIADH. Med J Austral 996; 64: Selective Serotonin Reuptake Inhibitor SSRI ; 42: SSRI SIADH 2002; 42: Hwang AS, Magraw RS, Syndrome of inappropriate secretion of antidiuretic hormone due to fluoxetine letter. Am J Psychiatry 989; 43: Cohen BJ, Mahelsky MM, Adler L, More case of SIADH with fluoxetine letter. AmJPsychiatry 990; 47: Vishwanath BM, Navalgund AA, Cusano W, Navalgund KA: Fluoxetine as a cause of SI- ADH letter. Am J Psychiatry 99; 48: Blackstein JV, Birt JA: Syndrome of inappropriate secretion of antidiuretic hormone secondary to fluoxetine. Ann. Pharmacotherapy 995; 27: Ayonrinde OT, Reutens SG, Sanfilipp FM: Paroxetine-induced SIADH letter. Med J Austral 995; 63: Spigest O, Mjorndal T: The e#ects of fluvoxamine on serum prolactin and sodium concen- 62

5 SSRI SIADH 58 trations: relation to platelet 5-HT2A receptor status. J Clin Psychopharmacol 997; 7: :. Jan Pharmacol Ther 2003; 3: , SSRI : I 3 0, mg Jan Pharmacol Ther 2000; 28 Suppl. : S47S68. 3,,, SSRI : I 5 20 mg. Jan Pharmacol Ther 2000; 28Suppl. : S89S0. 4 Phillips PI: Pharmacological aspects of electrolyte disturbances in older people. Austral J Hospital Pharmacy 996; 26: Sharma H, Pompei P: Antidepressant-induced hyponatremia in the age. Avoidance and management strategies. Drug aging 996; 8: Miller M. Hyponatremia: age-related risk factors and therapy decisions. Geriatrics 998; 53: Asbert M, Gines A, Gines P, Jimenez W, Claria J, Salo J, Arroyo V, Rivera F, Rodes J: Circulating levels of endothelin in cirrhosis. Gastroenterology 993; 04: Henriksen JH, Bendtsen F, Gerbes AL, Christensen NJ, Ring-Larsen H, Sorensen TI: Estimated central blood volume in cirrhosis. Hepatology 992; 6: Arroyo V, Bosch J, Gaya-Beltran J, Kravetz D, Estrada L, Rivera F, Rodes J: Plasma renin activity and urinary sodium excretion as prognostic indicators in nonazotemic cirrhosis with ascites. Ann Int Med 98; 94: Dalho# K, Almdal TP, Bjerrum K, Keiding S, Mengel H, Lund J: Pharmacokinetics of paroxetine in patients with cirrhosis. Eur J Clin Pharmacol 99; 4:

6 582 Abstract ACase of Severe Hyponatremia Induced by Selective Serotonin Re-uptake Inhibitor SSRI in Elder Patients with Hepatitis C Virus HCV-Related Liver Cirrhosis Hiroki Ikeda,Hiroshi Yotsuyanagi,Syunichi Yamauchi,Yoshihiko Nagase, Toshiya Ishii,Michihiro Suzuki,Takuyuki Katabami 2,Sayuri Shirai 3, Takashi Yasuda 3,andFumio Ito The case was a 78-year-old female with a history of hepatitis C virus HCV-related liver cirrhosis and hepatocellular carcinoma HCC. She had several times undergone treatments for HCC. She was admitted to St. Marianna University hospital in November 2003 because of depression with reduced daily activity. On admission, the levels of serum albumin, bilirubin, alanine aminotransferase, creatinine, and urea nitrogen were 3.7 mgml,. mgml, 44 IUl,.9 mgml, and 20.8 mgml, respectively. The concentration of sodium, chloride and potassium was 28 meql, 94 meql and 4.5 meql each. Hyponatremia was presumably caused by anorexia on depression. Either ascites nor edema was observed. She started a half dose of oral paroxetine hydrochloride 0 mgday, akind of selective serotonin re-uptake inhibitor SSRI, forthe treatment of depression. Three days after that, she became somnolent. Serum sodium concentration decreased to 6 meql. Urinary sodium and osmolarity increased to 97 meql and 43 mosmkgh 2O, respectively. Serum ADH concentration was.58 pgml. She was diagnosed as su#ering from syndrome of inappropriate anti-diuretic hormone SIADH. Inspite of drug withdrawal and fluid restriction, serum sodium concentration level decreased to 03 meql after two days. Hypertonic saline infusion was started, and then serum sodium slowly increased. Two weeks after treatment, serum sodium level got as high as 32 meql. SSRI is an important cause of SIADH especially in elderly people. In the present case, complicated by cirrhosis and presumably by anti-diuretic hormone ADH hypersecretion, she su#ered from severe hyponatremia soon after the prescription of SSRI, which stimulates secretion of ADH. Elder patients with liver cirrhosis may be vulnerable to SIADH by SSRI and should be carefully observed. Department of Internal Medicine, Division of Gastroenterology and Hepatology 2 Department of Internal Medicine, Division of Metabolism and Endcrinology 3 Department of Internal Medicine, Division of Nephrology and Hypertension St. Marianna University School of Medicine 64