Syndrome Of Inappropriate Antidiuretic Hormone Research Articles

Clinical analysis of 103 cases of tuberculous meningitis complicated with hyponatremia in adults.

Tuberculous meningitis (TBM) is a common infection of the central nervous system. TBM with hyponatremia is very common. If hyponatremia is not treated properly, it might affect the outcome of TBM patients. We included 226 patients diagnosed with TBM who were admitted from August 2010 to August 2015 and retrospectively analyzed the clinical data of patients with and without hyponatremia. In total, 45.6% (103/226) patients had hyponatremia and 54.4% (123/226) patients did not have hyponatremia. Serum sodium and severity of TBM were independent prediction factors of poor outcomes in TBM. The prognosis of patients with hyponatremia was worse than that of patients without hyponatremia. The mortality was 3.9% (4/103) in the hyponatremia group, while 0% (0/123) in the non-hyponatremia group. The degree of hyponatremia was related to imaging, cerebrospinal fluid (CSF) cell count and protein, severity of TBM, time to correct hyponatremia, and prognosis. We analyzed the causes of hyponatremia and found syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was the most common cause (77.7%, 80/103), followed by cerebral salt wasting (CSW) (17.5%, 18/103). Comparing SIADH and CSW, there was a significant difference in mean blood pressure, albumin, and hematocrit, and no significant difference in demographic characteristics, imaging, CSF cell count and protein, severity, occurrence and correction time of hyponatremia, or prognosis. TBM with hyponatremia was dominated by moderate hyponatremia, which often manifested as SIADH. The more severe hyponatremia was, the longer the correction time of hyponatremia, which will affect the prognosis of TBM patients.

Cerebral Salt Wasting Syndrome: A Complication of Meningitis in Hydrocephalus with VP Shunt:

Cerebral salt wasting syndrome (CSWS) is an important cause of persistent hyponatremia in children admitted to the intensive care unit. It needs to be promptly differentiated from the syndrome of inappropriate antidiuretic hormone (SIADH) secretion as a cause of hyponatremia in pediatric neurological patients. These two entities often have similar presenting symptoms however the treatment of both can be drastically different, which makes the distinction critical. We present a 6-month-old male child with hydrocephalus secondary to aqueductal stenosis, a blocked VP shunt, meningitis, and hyponatremia. A diagnosis of CSWS was considered and fludrocortisone was started. The patient improved gradually with a reduction in urine output and a gradual increase in serum sodium levels. A diagnosis of CSWS should be strongly considered in hyponatremic pediatric patients with significant natriuresis and suitable treatment should be initiated promptly to prevent long-term neurologic sequelae.

Influence of osmolality on gastrointestinal fluid volume and drug absorption: potential impact on oral salt supplementation

BackgroundThe syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is the most frequent cause of hyponatremia in patients with cerebrovascular disease, and is often treated with oral salt tablets. However, we have shown that osmolality-dependent variations in gastrointestinal (GI) fluid volume can alter the concentration of a poorly permeable drug in the GI tract, potentially affecting its absorption. Here, we examined the effect of ingestion of hyperosmotic solution (10% NaCl) on drug concentration and absorption in the GI tract.MethodsThe effects of osmolality on luminal fluid volume and drug absorption in rat intestine (jejunum, ileum and colon) were examined by means of an in situ closed loop method using fluorescein isothiocyanate-dextran 4000 (FD-4) and atenolol. In vivo absorption in rats was determined by measuring the plasma concentration after oral administration of the test compounds dissolved in purified water or hyperosmotic solution (10% NaCl).ResultsAdministration of hyperosmotic solution directly into the GI tract significantly increased the GI fluid volume, owing to secretion of water into the lumen. After administration in hyperosmotic solution, the luminal concentration of non-permeable FD-4 was significantly lower than the initial dosing concentration, whereas after administration in purified water, the luminal concentration exceeded the initial concentration. The fraction absorbed of atenolol was markedly lower after administration in hyperosmotic solution than after administration in purified water. An in vivo pharmacokinetic study in rats was consistent with these findings.ConclusionsAdministration of hyperosmotic NaCl solution increased GI fluid volume and reduced the plasma level of orally administered atenolol. This may imply that oral salt tablets used to treat hyponatremia in SIADH patients could decrease the intestinal absorption of concomitantly administered drugs, resulting in lower plasma exposure.

Can treatment response to SGLT2-inhibitors in syndrome of inappropriate antidiuresis be predicted by copeptin, natriuretic peptides and inflammatory markers?

Purpose The syndrome of inappropriate antidiuresis (SIAD) is the main cause of hyponatremia and the SGLT2-inhibitor empagliflozin is a promising new treatment option. A biomarker predicting treatment response could optimize treatment success. Materials and methods Secondary analysis of a trial including 84 hospitalized patients with SIAD-induced hyponatremia. Patients were randomized to four days of treatment with empagliflozin 25 mg/d (n = 43) or placebo (n = 41) with both groups receiving fluid restriction <1000 ml/d. Baseline levels of copeptin, the natriuretic peptides MR-proANP and NT-proBNP and C-reactive protein (CRP) were evaluated as predictors for treatment response defined as absolute sodium change, using linear regression models. Additionally, urinary sodium was assessed as predictor for non-response to fluid restriction alone by constructing the receiver-operating characteristic (ROC) curve. Results No clinically relevant predictive value for treatment response to empagliflozin could be found for copeptin, MR-proANP, NT-proBNP or CRP. A urinary sodium cut-off of >76 mmol/l led to a specificity of 91.7% [95% confidence interval (CI): 75%, 100%] and sensitivity of 51.9% [33.3%, 70.4%] to predict non-response to fluid restriction alone. Conclusions Based on our data, no biomarker could be identified as predictor for treatment response to empagliflozin. Urinary sodium was confirmed as a good marker for non-response to fluid restriction in SIAD patients. Clinical trial registration: ClinicalTrials.gov (Number: NCT02874807)

Potential Use of Pharmacogenetics to Reduce Drug-Induced Syndrome of Inappropriate Antidiuretic Hormone (SIADH).

Syndrome of inappropriate antidiuretic hormone (SIADH) is a common cause of hyponatremia, and many cases represent adverse reactions to drugs that alter ion channel conductance within the peptidergic nerve terminals of the posterior pituitary. The frequency of drug-induced SIADH increases with age; as many as 20% of patients residing in nursing homes have serum sodium levels below 135 mEq/L. Mild hyponatremia is associated with cognitive changes, gait instability, and falls. Severe hyponatremia is associated with cerebral edema, seizures, permanent disability, and/or death. Although pharmacogenetic tests are now being deployed for some drugs capable of causing SIADH (e.g., antidepressants, antipsychotics, and opioid analgesics), the implementation of these tests has been based upon the prior known association of these drugs with other serious adverse drug reactions (e.g., electrocardiographic abnormalities). Work is needed in large observational cohorts to quantify the strength of association between pharmacogene variants and drug-induced SIADH so that decision support can be developed to identify patients at high risk.

English

BACKGROUND Hyponatremia is the most frequently encountered electrolyte abnormality in hospitalized patients, especially those with neurological injury. Acute onset hyponatremia is common in patients with any type of cerebral insult including traumatic brain injury (TBI), subarachnoid haemorrhage (SAH) and brain tumours. Also seen as a complication of intracranial procedures, contributing to increased morbidity and mortality. Early diagnosis and effective management can reduce mortality associated with this condition. This study was done to estimate the prevalence of hyponatremia in neurosurgical patients in our institution. METHODS This is an observational study that analysed the adult patients admitted to the neuro intensive care unit (ICU) after having undergone the neurosurgical procedure from January 2019 to July 2019. A structured questionnaire was used for data collection. The prevalence of hyponatremia was calculated with preoperative serum sodium levels in the study population. RESULTS In this study with 61 patients undergoing neurosurgical procedures, the prevalence of hyponatremia was 34.4 %. The majority of patients for surgery comes between 41 to 50 years. 57.4 % cases were with traumatic brain injury, 11.5 % cases were with sub arachnoid haemorrhage and 31.1 % were with intracranial tumour. 26 % of hyponatremia patients belonged to mild grade while 8 % to moderate grade. 62.5 % of patients above 70 years, 44.4 % of patients between 51 to 60 years and 40 % of patients between 61 and 70 years presented with mild hyponatremia. 37.5 % of patients above 70 years and 10 % of patients between 61 and 70 years presented with moderate hyponatremia. CONCLUSIONS Our study showed an increased prevalence of hyponatremia in neurosurgical patients which demand effective approaches for an accurate and timely diagnosis of this electrolyte disorder. Hyponatremia frequently occurs in patients with TBI, SAH and intracranial tumours. It is also essential to differentiate between syndrome of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting syndrome (CSW) as the treatment modalities are entirely different for these two entities. Early detection, close monitoring, etiological evaluation and prompt treatment based on aetiology can reduce the complications and improve patient’s outcomes. KEYWORDS Electrolyte Abnormality; Brain Injury, Morbidity

Hyponatremia in Children and Adults with Prader-Willi Syndrome: A Survey Involving Seven Countries.

In Prader–Willi syndrome (PWS), conditions that are associated with hyponatremia are common, such as excessive fluid intake (EFI), desmopressin use and syndrome of inappropriate antidiuretic hormone (SIADH) caused by psychotropic medication. However, the prevalence of hyponatremia in PWS has rarely been reported. Our aim was to describe the prevalence and severity of hyponatremia in PWS. In October 2020, we performed a retrospective study based on the medical records of a large cohort of children and adults with PWS from seven countries. Among 1326 patients (68% adults), 34 (2.6%) had at least one episode of mild or moderate hyponatremia (125 ≤ Na < 135 mmol/L). The causes of non-severe hyponatremia were often multi-factorial, including psychotropic medication in 32%, EFI in 24% and hyperglycemia in 12%. No obvious cause was found in 29%. Seven (0.5%) adults experienced severe hyponatremia (Na < 125 mmol/L). Among these, five recovered completely, but two died. The causes of severe hyponatremia were desmopressin treatment for nocturnal enuresis (n = 2), EFI (n = 2), adrenal insufficiency (n = 1), diuretic treatment (n = 1) and unknown (n = 1). In conclusion, severe hyponatremia was very rare but potentially fatal in PWS. Desmopressin treatment for nocturnal enuresis should be avoided. Enquiring about EFI and monitoring serum sodium should be included in the routine follow-ups of patients with PWS.

Low sodium and tolvaptan have opposite effects in human small cell lung cancer cells

PurposeHyponatraemia is frequently observed in cancer patients and can be due to the syndrome of inappropriate anti-diuresis (SIAD), related to ectopic vasopressin secretion, particularly in small cell lung cancer (SCLC). Hyponatraemia is associated with a worse outcome in cancer patients. The vasopressin receptor antagonist tolvaptan effectively corrects hyponatraemia secondary to SIAD and there is in vitro evidence that it has also an antiproliferative effect in cancer cells. The purpose of this study was i) to analyse the effect of low serum sodium concentrations ([Na+]) in SCLC cells and ii) to determine whether tolvaptan counteracts tumor progression. MethodsWe evaluated cell proliferation, cell cycle, apoptosis, oxidative stress, invasivity in low [Na+] as well as after exposure to tolvaptan. We also analysed the intracellular signalling pathways involved. ResultsIn reduced [Na+] cell proliferation was significantly increased compared to normal [Na+] and cells were mostly distributed in the G2/M phase. Apoptosis appeared reduced. In addition, the ability to cross matrigel-coated membranes markedly increased. As observed in other cancer cell models, the expression of the heme-oxigenase-1 gene was increased. Finally, we found that in cells cultured in low [Na+] the RhoA/ROCK1/2 pathway, which is involved in the regulation of actin cytoskeleton, was activated. On the other hand, we found that tolvaptan effectively inhibited cell proliferation, anchorage-independent growth, invasivity and promoted apoptosis. Accordingly, the RhoA/ROCK-1/2 pathway was inhibited. ConclusionsThese findings demonstrate for the first time that low [Na+] favours tumor progression in SCLC cells, whereas tolvaptan effectively inhibits cell proliferation, survival and invasivity.

AKI In Suspected Meningitis/Encephalitis May Be "Avoidable Kidney Injury".

AKI In Suspected Meningitis/Encephalitis May Be "Avoidable Kidney Injury".

Hyponatremia: It’s in the Eye of the Beholder: Pitfalls in the Diagnosis and Treatment of SIADH with Desalination due to Herpes Zoster Ophthalmicus (HZO)

Herpes Zoster Ophthalmicus (HZO) is a rare cause of SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone secretion). It occurs when herpesvirus type 3 activation presents in the first division, or ophthalmic division of the trigeminal nerve.

English

BACKGROUND Community acquired pneumonia (CAP) refers to pneumonia contracted by a person with little or no contact with health care system. Severity scores like CURB 65 severity score are useful in estimating the outcome. Hyponatremia is defined as serum sodium level &lt; 135 mEq/L. The incidence of hyponatremia at hospital admission among CAP patients is found to be 28 %and the mechanism behind it has been found to be due to syndrome of inappropriate antidiuretic hormone secretion (SIADH). Hence this study is an effort to explore how hyponatremia is associated with severity and outcomes, in hospitalized patients with pneumonia. The purpose of this study was to assess the proportion of hyponatremia in patients with community acquired pneumonia and compare hyponatremia with CURB-65 as an initial screening tool for assessment of severity of CAP. METHODS This is a hospital-based cross-sectional study. 75 community acquired pneumonia patients admitted as inpatients are included in this study. Information is collected and detailed history is taken using pre-formed proforma at the time of admission. Serum sodium levels were measured, after initial assessment of patients. The lab values of serum sodium levels were analysed with the clinical profile and outcome in these study groups. RESULTS In our study, it was observed that as the sodium levels are decreasing, the CURB 65 score increases. Study subjects who had sodium levels &lt; 125 mg/dl, presented with CURB 65 score as 4 (30 %). Inversely, the study subjects with high sodium levels (&gt; 135 mg/dl) had CURB 65 scores as 1 (75 %). The association between sodium levels and CURB 65 score was significant in patients who got discharged but not in patients who expired. CONCLUSIONS Present study of serum sodium levels as biomarkers in CAP showed that hyponatremia carried poor prognosis which correlated with high CURB 65 score. KEYWORDS Sodium, Community Acquired Pneumonia, SIADH, CURB 65, Hyponatremia, COPD

Asymptomatic meningitis diagnosed by positron emission tomography in a patient with syndrome of inappropriate antidiuretic hormone secretion: a case report

BackgroundSyndrome of inappropriate antidiuretic hormone secretion can be caused by arginine-vasopressin-producing tumors or enhanced arginine vasopressin secretion from the posterior pituitary gland due to central nervous system disorders and intrathoracic diseases.Case presentationA 53-year-old Asian man was hospitalized with complaints of tremor and hiccups. Laboratory examination revealed findings suggestive of hypotonic hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion. The patient did not complain of headache or photophobia, and showed no signs of meningeal irritation. Positron emission tomography–computed tomography revealed 18F-fluoro-deoxy-glucose accumulation along the cervical spinal cord, based on which the patient was diagnosed as having aseptic meningitis. The hyponatremia was treated successfully by fluid restriction, and optimum plasma sodium concentration was maintained by tolvaptan administration.ConclusionsThis case underscores the need to consider the possibility of mild meningitis as the cause of syndrome of inappropriate antidiuretic hormone secretion in patients without other identifiable cause.

Pituitary, Thyroid, and Parathyroid Disorders

Critically ill patients may have preexisting endocrine disorders that need to be recognized and addressed. Disruption of normal endocrine gland function leads to inappropriate hormone secretion, resulting in hormone excess or deficiency. Both extremes may have detrimental systemic consequences and may pose significant challenges to the intensivist. Proper recognition of endocrine emergencies such as severe hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion, thyroid storm, and myxedema coma is vital, as delay in treatment may result in significant morbidity or death. This review provides an overview of common pituitary, thyroid, and parathyroid disorders and emergencies, including definitions, manifestations, diagnosis, and management. This review contains 2 figures, 7 tables, and 30 references. Key Words: acromegaly, diabetes insipidus, hyperparathyroidism, hypoparathyroidism, myxedema coma, nonthyroidal illness syndrome, syndrome of inappropriate antidiuretic hormone secretion, thyrotoxicosis, thyroid storm

Cerebral Salt Wasting Syndrome (CSWS) and Potentially Fatal Neurosurgical Hyponatremia

Background: Hyponatremia is considered as a common electrolyte imbalance in hospitalized patients. Cerebral salt wasting syndrome (CSWS) is an abnormality in the renal sodium transport in patients with intracranial disease, in the face of preserved thyroid and adrenal function. However, treatment of CSW and syndrome of inappropriate antidiuretic hormone (SIADH) varies, making an accurate diagnosis significant. In order to differentiate CSWS from syndrome of inappropriate antidiuretic hormone (SIADH), this study aimed to detect CSWS related hyponatremia (benign and reversible condition) in its early stages. Methods: This retrospective cross-sectional study was conducted at the Department of Neurosurgery, Ziauddin Medical University Hospital, Karachi, Pakistan from August 2016 to August 2019. All patients who had a cerebral lesion along with hyponatremia and natriuresis were included. Patients with SIADH, though considered in the differential diagnosis, were not included in the study. Data was analyzed by using SPSS (Statistical Package for the Social Sciences) and p&lt;0.05 was considered statistically significant. Results: A total of 39 patients in a period of three years were found with CSWS-related hyponatremia, predominantly males 28(71.8%), who were operated for cranial tumors 15(38.46%). All 39(100%) had an increased uric acid level. After treatment 31(79.5%) developed post-florinef hypokalemia, while, potassium remained unaffected in 8(20.5%). Hypokalemia was noted in majority of the patients 31(79.5%) treated with fludrocortisones. Conclusion: Cerebral salt wasting syndrome was found high among males with cranial tumors. Hyponatremia in CSWS patients was found challenging if untreated might lead to mortality. However, treatment with intravenous normal saline and fludrocortisone was successful in this course. Keywords: Hyponatremia; Natriuresis; Hypovolemia; Syndrome.

Chronic hyponatremia based on maxillary sinus mass.

SummaryThis is a case report of a child with chronic hyponatremia due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) as a paraneoplastic manifestation of olfactory neuroblastoma (OFN). We hereby report a clinical presentation as well as a pragmatic approach to one of the most common electrolytic disorders in the pediatric population and have emphasized the necessity of involving the sinonasal area in the diagnostic procedure while evaluating possible causes of SIADH. This report indicates that the chronicity of the process along with the gradual onset of hyponatremia occurrence is responsible for the lack of neurological symptoms at the moment of disease presentation.Learning pointsHyponatremia is not infrequently attributed to SIADH.Paraneoplastic syndromes are uncommon but they should be considered in the differential diagnosis of pediatric SIADH.Chronic insidious hyponatremia may not be associated with clear neurological symptoms despite its severity.

Increased Mortality in Elderly Patients Admitted with Hyponatremia: A Prospective Cohort Study.

Hyponatremia is the most common electrolyte disorder, commonly affecting older hospitalized individuals; however, the literature is not clear regarding its effect on mortality. The aim of this 2-year observational prospective cohort study was to evaluate the mortality and re-admission rates, the clinical and laboratory characteristics and the causes of hyponatremia in patients older than 65 years admitted with a corrected serum sodium of 130 mEq/L or less in an internal medicine ward of a tertiary Greek university hospital. During the observation period, 138 patients (mean age 80.5 years, 36.2% male) fulfilled the inclusion criteria and were prospectively followed for 1 year after admission. Symptoms of hyponatremia were present in 59.4% of patients. Hypovolemia was the main sole cause of hyponatremia, but in about one third of patients, hyponatremia was multifactorial. Only a low proportion of patients (12.3%) fulfilled the criteria of the syndrome of inappropriate antidiuresis (SIAD) at admission according to the current guidelines. The re-admission rates at 3- and 12-months following discharge was 34.2% and 51.8%, respectively. Mortality during hospitalization was 17.4% and was higher compared to non-hyponatremic admitted older patients, while the total mortality at 1 year after admission was 28.3%, indicating that hyponatremia at admission is a marker of significant mortality during and after hospitalization in elderly patients.

Aetiological diagnosis of hyponatraemia in non-critical patients on total parenteral nutrition: A prospective multicentre study

BackgroundIn patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN. MethodsProspective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone. Results162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%). ConclusionsSIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.

MO13-5 Clinical features and prognosis of patients with unresectable locally advanced or metastatic olfactory neuroblastoma

Olfactory neuroblastoma is especially rare cancer of the nasal cavity, with an incidence of 0.03 per 100,000 in Japan. Combining surgery, chemotherapy, and radiotherapy are offered to manage this tumor, but no standard treatment has been established. We retrospectively reviewed patients with unresectable locally advanced or metastatic olfactory neuroblastoma who received chemotherapy between January 2015 and August 2020 at the National Cancer Center Hospital (Tokyo, Japan). A total of 10 patients were identified, with a median age of 46.5 (range 30-73). There were 5 men and 5 women each. Seven patients presented initially unresectable disease and three patients presented with recurrent disease after surgery. Among unresectable cases, modified Kadish staging C/D was 4/3, most patients underwent chemotherapy followed by radiotherapy. Vincristine, doxorubicin and etoposide (VDC)/platinum (cisplatine or carboplatine) and etoposide/others were administrated in 4/3/1 patient, respectively. Regimen change from cisplatin to carboplatin was occurred in 3 patients, one was hearing impairment, and the others was due to Syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Response rate was 75% (95% confidence interval [CI] 30-95) with VDC and 33% (95% CI 10-70) with platinum-based chemotherapy (p=0.52, Fisher's exact test). Median progression-free survival of initial chemotherapy was 14.2 months (95% CI 1.1-NE). Overall survival from the initiation of chemotherapy for unresectable disease was 36.7 months (95% CI 11.7-36.7). In the clinical setting, multimodal therapeutic approach is necessary in case of unresectable olfactory neuroblastoma. In some cases, VDC or platinum-based therapy showed relatively better response in spite of a late recurrence. Therefore, long term follow-up is mandatory.

Analysis of the Frequency and Onset Time of Hyponatremia/Syndrome of Inappropriate Antidiuretic Hormone Induced by Antidepressants or Antipsychotics

Hyponatremia and syndrome of inappropriate antidiuretic hormone (SIADH) is a potentially fatal adverse effect of antidepressants (ADs) and antipsychotics (APs), although its frequency and onset time have not been well documented. To analyze the frequency and onset time of AD- or AP-induced hyponatremia/SIADH. We used plural data-mining techniques to search the US Food and Drug Administration Adverse Event Reporting System (FAERS) database for reports on hyponatremia/SIADH induced by psychotropic drugs from January 2004 to June 2020. For each item, we assessed the reporting odds ratio, 95% CI, median onset time, and Weibull distribution parameters. We identified 36 422 reports related to hyponatremia/SIADH. Signals were detected for all psychotropic drugs that we analyzed, except for clozapine. The median onset time of total AD-induced hyponatremia/SIADH was shorter than that of AP. For all ADs and APs except clozapine, hazards were considered to be the early failure type. In contrast, the hazard of clozapine was considered to be the random failure type. The limitations of this study included several reporting biases and the presence of confounding variables, particularly age. Most ADs and APs were found to be associated with a risk for hyponatremia/SIADH. In addition, sufficient attention should be paid to signs of hyponatremia/SIADH in the early phase when most ADs and APs are administered. These data are potentially useful for determining AD- or AP-induced hyponatremia/SIADH in the early stage and for preventing its further aggravation into a serious condition.

Administration of a Divided Dose of Carboplatin Following Carboplatin-Induced Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH): A Case Report

Chemotherapy-induced severe hyponatremia is a life-threatening condition. Platinum-based agents play a key role in ovarian cancer treatment, but they are more likely to cause hyponatremia than other anti-cancer agents. The optimal strategy for treating ovarian cancer in the case of severe hyponatremia induced by the platinum agent remains unclear. We report the case of 77-year-old women with multiple peritoneal recurrences five years and eight months after surgery for ovarian clear cell carcinoma. She received tri-weekly docetaxel and carboplatin (DC) therapy and bevacizumab, following which she developed severe hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH).