Abstract
The Syndrome of Inappropriate Antidiuretic Syndrome (SIADH) in association with Riluzole and SSRI treatment in an ALS patient
Highlights
IntroductionAmyotrophic Lateral Sclerosis (ALS), known as Motor Neuron Disease (MND) is a progressive neurodegenerative disease of both upper and lower motor neurons, classically affecting adults around the ages 45-63, for which no cure is currently available [1,2,3,4,5]
Amyotrophic Lateral Sclerosis (ALS), known as Motor Neuron Disease (MND) is a progressive neurodegenerative disease of both upper and lower motor neurons, classically affecting adults around the ages 45-63, for which no cure is currently available [1,2,3,4,5].Riluzole is the first FDA-approved medication for ALS, known to modestly increase survival in patients [2,6]
The mechanism remains incompletely understood, proposed mechanisms suggest the following: 1) SIADH secondary to hypoxia and hypercapnia, 2) an intrathoracic circulation dysfunction leading to SIADH, and 3) emotional factors and physical stress contributing to eventual SIADH development [6,10]
Summary
Amyotrophic Lateral Sclerosis (ALS), known as Motor Neuron Disease (MND) is a progressive neurodegenerative disease of both upper and lower motor neurons, classically affecting adults around the ages 45-63, for which no cure is currently available [1,2,3,4,5]. Few reports in literature describe single cases in which ALS patients presented with, or developed, hyponatremia with features compatible with a diagnosis of SIADH [1,7,8,9,10] These cases were commonly associated with progressive respiratory deterioration, eventually leading to respiratory failure requiring mechanically ventilating the patient. Diagnosis was suspected following two years of symptoms including progressive muscle weakness, night cramps, breathing difficulties and difficulty expectorating sputum With his diagnosis, the family of the patient reported increasingly low fluid intake and constipation, as well as symptoms of depression. Following eight days of mechanical ventilation in combination with IV fluid treatment containing sodium chloride at hypertonic, and later eutonic concentrations, the patient’s blood work showed return to normal serum sodium and osmolarity levels.
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