Paroxetine is a well-known selective serotonin reuptake inhibitor, and has been reported to be advantageous for chronic pain control. Paroxetine is increasingly used for various types of chronic pain because of its safety; however, hyponatremia, or syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with paroxetine, has been reported. This complication is relatively rare, but some patients have presented with severe neurological symptoms. Here, we report the first case of SIADH associated with paroxetine in Korea.
Chronic Pain ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Korea ; Paroxetine ; Serotonin

To summarize and analyze the causes of hyponatremia in patients with brucellosis and explore the clinical manifestations of syndrome of inappropriate antidiuresis(SIAD)in patients with brucellosis. The clinical data of 111 patients with acute brucellosis who were treated in Peking Union Medical College Hospital from September 2011 to December 2017 were retrospectively reviewed.Hyponatremia was defined by serum sodium level lower than 135 mmol/L.Clinical characteristics including medical histories,vital signs,and laboratory test findings were collected and analyzed. Hyponatremia was found in 14(12.6%)of 111 patients with brucellosis,among whom 3 patients were confirmed to be with SIAD,10 were suspected as SIAD,and 1 was diagnosis as hypopituitarism.Hypoalbuminemia,elevation of erythrocyte sedimentation rate,and high sensitivity C reactive protein were found in brucellosis patients with SIAD,along with severe complications such as infective endocarditis,septic shock,and anemia. Hyponatremia is not a rare condition in brucellosis patients and may be caused by SIAD.
Brucellosis ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Retrospective Studies

Neuromyelitis optica spectrum disorder (NMOSD) may present with area postrema syndrome, which is characterized by intractable vomiting and hiccups. Hyponatremia is common in NMOSD and is mostly associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). In contrast to SIADH, cerebral salt wasting syndrome (CSWS) causes hyponatremia, which is associated with severe natriuresis and extracellular volume depletion in patients with cerebral disease. To our knowledge, hyponatremia associated with CSWS has not been reported in a patient with NMOSD. Here, we describe a NMOSD presenting with hyponatremia, which may be caused by CSWS following area postrema syndrome.
Area Postrema ; Hiccup ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Natriuresis ; Neuromyelitis Optica* ; Vomiting ; Wasting Syndrome*

The most common cause of hyponatremia in hospitalized patients is syndrome of inappropriate antidiuretic hormone secretion (SIADH) characterized by water retention leading to decreased serum sodium concentration and osmolality. Since the report of Schwartz and his co-workers1), this syndrome has been described in various clinical settings. There are some reports on SIADH associated with Guillain-Barre syndrome in the literature2-6). However, to our knowledge, there was only one reported case of SIADH associated with Guillain-Barre syndrome in Korea
Guillain-Barre Syndrome* ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome* ; Korea ; Osmolar Concentration ; Sodium ; Water

The authors report a case of cerebral salt wasting(CSW) syndrome followed by diabetes insipidus and meningitis after transsphenoidal approach for pituitary adenoma. Fluid and electrolyte imbalance occurs occasionally in neurosurgical patients due to DI or SIADH, however, CSW is different disease entity and the methods of treatment are different from those of DI or SIADH. A number of studies in recent years have shown that hyponatremia in many patients with intracranial disease might actually be caused by CSW in which a renal loss of sodium leads to hyponatremia and massive urinary water loss. CSW of this patient was resolved by fluid and salt replacement after 6 months.
Diabetes Insipidus ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Meningitis* ; Meningitis, Bacterial ; Pituitary Neoplasms* ; Pseudomonas* ; Sodium ; Wasting Syndrome*

Although hyponatremia is a common electrolyte disorder, its evaluation and management are not well defined. When diagnosed, hyponatremia should be categorized based on four criteria: volume status, urinary Na+, serum K+, and acid-base balance. This approach helps to determine what the cause of hyponatremia is and how it should be treated. Initially, hypovolemic hyponatremia, including cerebral salt wasting syndrome (CSWS), is treated by volume resuscitation and salt supplementation. Euvolemic hyponatremia, including the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), is treated by fluid restriction and salt supplementation, and hypervolemic hyponatremia is treated by fluid restriction and salt restriction. Hyponatremia can be managed well using these primary treatments and medications.
Acid-Base Equilibrium ; Hyponatremia ; Hypovolemia ; Inappropriate ADH Syndrome ; Resuscitation ; Wasting Syndrome

The syndrome of inappropriate antidiuretic hormone secretion has only been reported in a few patients with large cell neuroendocrine carcinoma (LCNEC); however, it has never been reported in a patient with LCNEC of the lung, whose serum sodium levels were normalized after surgical resection of the mass. A 63-year-old male presented with a two-day history of dizziness and recent memory loss. On admission, his serum sodium level was 113 mEq/L with a serum osmolality of 236 mosm/kg, a urine osmolality of 441 mosm/kg, and a urine sodium level of 65 mEq/L. His chest computed tomography revealed a 2.7x2.3 cm-sized mass in the left lower lobe. After surgical removal of the mass, his serum sodium concentrations were normalized, and histopathology of the mass revealed LCNEC.
Carcinoma, Large Cell/*pathology ; Carcinoma, Neuroendocrine/*pathology ; Humans ; Inappropriate ADH Syndrome/*pathology ; Male ; Middle Aged

The causes of hypo-osmolar hyponatremic patients without edema are mainly related to either SIADH (syndrome of inappropriate antidiuretic hormone secretion) or hypovolemia and the evaluation of extracelluar volume status can be a clue to differentiate between the two. As a diagnostic andtherapeutic tool, positive response to isotonic saline load test is recognized in favor of hypovolemic hyponatremia but there is a pitfall due to similar response in a subset of euvolemic hyponatremia, SIADH in case that combined with hypovolemia or accompanied by low sodium intake. In such case, water load test may provide more help for exact evaluation of hypovolemia and SIADH. Hereby, we report a case of a 74 year old patient with doubtful thymoma radiologically presented to emergency room with symptomatic severe hyponatremia (108 mEq/L) consistent with clinical and biochemical features of hypovolemia and positive response to initial isotonic saline infusion. However, episodes of hyponatremia recurred despite euvolemic status, which was diagnosed as SIADH by water load test. We initially considered thymoma as a cause of SIADH but its pathologic finding was a thymic cyst. And hyponatremia with hypovolemic feature recurred but the final diagnosis came out as idiopathic SIADH by repeated water load test. His hyponatremia was completely corrected by strict water restriction (<500 cc/day).
Edema ; Emergencies ; Humans ; Hyponatremia ; Hypovolemia ; Inappropriate ADH Syndrome ; Mediastinal Cyst ; Porphyrins ; Sodium ; Thymoma ; Water

Many patients whose chief complaint is headache caused by accident such as traffic accident, falling, or assaults visit to emergency center. Majority of these patients has mild or moderate symptoms, and there is no need to treat surgically. However, the fact that head injury can cause SIADH(syndrome of inappropriate secretion of antidiuretic hormone) is likely to be overseen. Acute hyponatremia might have been associated with death or permanent brain damage. Hyponatremia is best handled by early recognition and correction of a downward trend in the serum sodium. Unfortunately, this is often difficult in the head-injured patient, where hyponatremia may occur fairly rapidly and is confused by symptoms of head injury. when moderate to severe hyponatremia occurs, it is important to determine its etiology and expeditiously initiate corrective action. There has not been any reported case of the occurrence of symptomatic SIADH after mild head injury in Korea yet. The authors report the experience of three cases of symptomatic SIADH after mild head injury with review of the literatures.
Accidents, Traffic ; Brain ; Craniocerebral Trauma* ; Emergencies ; Head* ; Headache ; Humans ; Hyponatremia* ; Inappropriate ADH Syndrome ; Korea ; Sodium

A 54-year-old man was diagnosed as syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 7 days after lung transplantation, whereas the preoperative serum sodium level was normal. Hypertonic saline infusion with furosemide did not improve hyponatremia, however, tolvaptan corrected his serum sodium levels from 123 mEq/L to 131 mEq/L. Seven days after maintenance of tolvaptan, this drug was discontinued and hyponatremia did not occur. Herein, we report a case of SIADH after lung transplantation treated with tolvaptan.
Furosemide ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Lung Transplantation* ; Middle Aged ; Sodium