Valproate-induced severe symptomatic hyponatremia in a patient with schizoaffective disorder: a case study and literature review

Introduction The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a serious condition associated with persistently high ADH water retention despite sufficient vascular volume. Sodium valproate (VPA), an antiepileptic indicated to treat bipolar disorder, blocks sodium (Na) and calcium ions. Few studies have examined the association between VPA SIADH. Objectives This abstract has two interrelated objectives: (1) describe VPA-associated SIADH case study we encountered in our clinical setting; (2) review literature for other cases illuminate associations possible risk factors. Methods After recording from experiences, completed hyponatremia VPA. We reviewed resulting artticles searches PubMed aggregate Dartmouth Biomedical Library indices no date or language parameters. then searched those articles’ bibliographies. Results Ms. A 63-year-old woman schizoaffective type, hospitalized resurgence visual hallucinations (VH) “monsters” asking her hurt herself others. She had been adherent (500mg twice daily) non-adherent prescribed Olanzapine (25mg). On Day 1 (D1), labs were concerning serum Na 119mEq/L (n=135-145), osmolality (SOsm) 264mEq/L (n=275-295), inappropriately urine 111mOsm/kg (n <100 mosmol/kg hyponatremia) 34mEq/L <20 hypovolemic hyponatremia). Her level was 73.6 mcg/mL. restarted on home psychiatric medications VH, responded restriction, at 292mEq/L by D4 (see Figure). admitted inpatient unit concerns persistent VH. D13, SOsm worsened 267mEq/L discontinued that time. D19, improved 283mEq/L. VH well discontinuing adding Risperidone (titrated 6mg) D22 she discharged home. Given chronological sequence newly developed patient’s likely multifactorial, contribution hyponatremic encephalopathy-related psychosis. Our found ten articles reporting thirteen Table). patient shared demographics most previously reported cases: being older age having polytherapy low baseline Na. None previous reports showed specific drug interactions be particularly causes hyponatremia. Image: Image 2: Conclusions Although rare phenomenon, caution warranted when evaluating patients use presenting acutely psychosis These symptoms could manifestation Disclosure Interest Declared