Abstract
Donepezil and memantine are the acetylcholinesterase inhibitors most commonly used in clinical practice for the management of mild-moderate dementia in Alzheimer’s disease. Electrolyte abnormalities associated with the drugs are commonly encountered in daily clinical practice and often can lead to seizures. Hyponatremia is an uncommon adverse effects of acetylcholinesterase inhibitors. Here we present a case on hyponatremia seizure due to the syndrome of inappropriate antidiuretic hormone (SIADH) caused by the acetylcholinesterase inhibitor donepezil and memantine as other likely causes were ruled out by appropriate investigations. The causality assessment needed to be done according to Naranjo algorithm was found to be ‘probable’ and the level of severity according to the Hartwig scale was ‘Level 5’.
Highlights
Dementia is defined as a pathologic deterioration in cognitive abilities that impairs the productive performance of activities of daily living
The mechanism by which acetylcholinesterase inhibitors cause a syndrome of inappropriate antidiuretic hormone (SIADH) remains unclear
This case study reveals that acetylcholinesterase inhibitors could be causally related to the hyponatremia event
Summary
Dementia is defined as a pathologic deterioration in cognitive abilities that impairs the productive performance of activities of daily living It refers to a collection of symptoms that occur when brain cells stop working properly severe enough to interfere with occupational or social performance. Patient drug therapy was changed and started on acetylcholinesterase inhibitors (a combination of donepezil with memantine 5 mg/5 mg 1-0-0) in view of suspected dementia. The patient had an episode of generalized tonic-clonic seizure with tongue bite lasting for about 3-5 min followed by a drop in saturation. He was shifted to high dependency unit and endotracheal intubation was done for maintenance of oxygenation. The patient was restarted with antipsychotics (risperidone o.5 mg 0-0-1) and was discharged with the serum sodium level 136 mmol/l
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