Carbamazepine/levomepromazine
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Reactions 864 - 11 Aug 2001 S Carbamazepine/levomepromazine Syndrome of inappropriate antidiuretic hormone secretion leading to hyponatraemia: case report Syndrome of inappropriate antidiuretic hormone secretion (SIADH) leading to severe hyponatraemia occurred in a 40-year-old man receiving treatment with levomepromazine and carbamazepine [duration of treatment not stated] after he vomited and drank a large quantity of water. The man had a history of cerebral palsy, mental retardation and absence epilepsy and his treatment regimen consisted of carbamazepine 500 mg/day, levomepromazine 185 mg/day, biperiden, phenytoin, clonazepam and haloperidol. 30 minutes after he had vomited and then consumed approximately 6L of water over a 2-hour period, he experienced 6 grand mal seizures. He was hospitalised 7 hours later in an unresponsive state. Significant laboratory parameters included serum sodium level 98 mEq/L, serum osmolality 213 mOsm/kg of water, serum cortisol level 30.1 µg/dl (normal 2.7–15.5), urinary sodium level 47 mEq/L and urinary osmolality 398 mOsm/kg of water. He was diagnosed with hypotonic hyponatraemia with concentrated urine due to drug-induced SIADH, vomiting and excessive water consumption. He experienced another 4 grand mal seizures after admission to hospital. The man was treated with IV sodium chloride and furosemide. Ten hours after admission his seizures stopped and 6 hours later, his serum sodium level was 107 mEq/l. He was then given a weaker solution of IV sodium chloride and at 30 hours postadmission, his serum sodium level had increased to 117 mEq/L. He recovered with no further neurological effects. Author comment: ‘We should be aware that severe hyponatremia may develop in patients treated with drugs which can induce SIADH when further impairment of renal water excretion or excessive water intake occurs concomitantly.’ Matsumura M, et al. Severe hyponatremia in a patient treated with levomepromazine and carbamazepine. Internal Medicine 40: 459, May 2001 - Japan 807206270 1 Reactions 11 Aug 2001 No. 864 0114-9954/10/0864-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine/levomepromazine
Reactions 864 - 11 Aug 2001
SCarbamazepine/levomepromazine
Syndrome of inappropriate antidiuretic hormonesecretion leading to hyponatraemia: case report
Syndrome of inappropriate antidiuretic hormone secretion(SIADH) leading to severe hyponatraemia occurred in a40-year-old man receiving treatment with levomepromazineand carbamazepine [duration of treatment not stated] after hevomited and drank a large quantity of water.
The man had a history of cerebral palsy, mental retardationand absence epilepsy and his treatment regimen consisted ofcarbamazepine 500 mg/day, levomepromazine 185 mg/day,biperiden, phenytoin, clonazepam and haloperidol. 30minutes after he had vomited and then consumedapproximately 6L of water over a 2-hour period, heexperienced 6 grand mal seizures. He was hospitalised 7 hourslater in an unresponsive state. Significant laboratoryparameters included serum sodium level 98 mEq/L, serumosmolality 213 mOsm/kg of water, serum cortisol level 30.1µg/dl (normal 2.7–15.5), urinary sodium level 47 mEq/L andurinary osmolality 398 mOsm/kg of water. He was diagnosedwith hypotonic hyponatraemia with concentrated urine due todrug-induced SIADH, vomiting and excessive waterconsumption. He experienced another 4 grand mal seizuresafter admission to hospital.
The man was treated with IV sodium chloride andfurosemide. Ten hours after admission his seizures stoppedand 6 hours later, his serum sodium level was 107 mEq/l. Hewas then given a weaker solution of IV sodium chloride and at30 hours postadmission, his serum sodium level had increasedto 117 mEq/L. He recovered with no further neurologicaleffects.
Author comment: ‘We should be aware that severehyponatremia may develop in patients treated with drugswhich can induce SIADH when further impairment of renalwater excretion or excessive water intake occursconcomitantly.’Matsumura M, et al. Severe hyponatremia in a patient treated withlevomepromazine and carbamazepine. Internal Medicine 40: 459, May 2001 -Japan 807206270
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Reactions 11 Aug 2001 No. 8640114-9954/10/0864-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
