TITLE:
Serotonin syndrome and acute hyponatremia, complex overlapping syndromes, a case report and review
AUTHORS:
Muhammad E. Choudhry
KEYWORDS:
Sertraline; Hyponatremia; Serotonin Syndrome
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.2,
February
12,
2014
ABSTRACT: Objective: To report the first case of simultaneous serotonin syndrome
and acute hyponatremia secondary to sertraline and drug interactions
resulting in patients’ death (Naranjo ADR probability score 7). Case Summary:
An 83-year-old female on sertraline for 5 years for depression was admitted
for left tibial plateau fracture. She had a history of short bowel syndrome,
total parenteral nutrition and CKD stage 3 secondary to vascular disease. 2
weeks post operatively, she developed into difficulty concentrating, tachycardia,
hyperreflexia and clonus in context of opioids and antiemetic use but was
afebrile and haemodynamically stable. She also developed into acute
hyponatremia from 133 mmol/L to 127 mmol/L within 24 hours. Sertraline and antiemetic medications were stopped and cyproheptadine and diazepam were started to treat serotonin syndrome. The patient
deteriorated after an initial improvement. She developed into aspiration
pneumonia later and passed away in ICU. Discussion: Both acute hyponatremia and
serotonin syndrome share SSRIs as common etiology, which have acute onset and
rapid resolution and show multiple overlapping neurological features. Hunter criteria
are more accurate than Sternbach criteria due to less emphasis on mental
features to diagnose serotonin syndrome with
overlapping conditions with similar presentation. Hyponatremia causes
muscle weakness with hyporeflexia compared to serotonin syndrome with
hyperreflexia and clonus. Conclusion: Clinicians should be aware of
possibility of both acute hyponatremia and serotonin syndrome secondary to
SSRIs interacting with opioids and
ondansetron. The use of Hunter criteria would aid in prompting diagnosis
and initiation of timely treatment.