Biomedicine

Abstract

A sixty-year-old female was brought to the emergency for acute confusion. She was on treatment for hypertension and depression. The general physical examination and neurological examination were normal except for mild hypertonia. The immediate non-contrast computed tomography was unremarkable. However, her blood investigations revealed severe hyponatremia. On further evaluation, she was considered to have the syndrome of inappropriate antidiuretic hormone secretion (SIADH).  The patient had been taking sertraline for the past six months. In the absence of any other explanation, sertraline was attributed to be the cause of SIADH. Sertraline is a selective serotonin reuptake inhibitor (SSRI). Though SSRIs are considered to selectively inhibit reuptake of serotonin, they also inhibit reuptake of noradrenaline as well. Noradrenaline can stimulate the release of ADH through alpha one receptor. The patient was treated with hypertonic saline with close monitoring of serum sodium level. As the serum sodium level increased, the patient’s sensorium gradually improved. Sertraline was discontinued and the patient was discharged with antihypertensives. On subsequent follow-up, she remained stable and asymptomatic.