olanzapine and Hyponatremia

Hyponatremia is occasionally unmasked in psychiatric patients during hospitalization after routine blood and urinary tests, and correlates in most cases with an inappropriate secretion of antidiuretic hormone, mainly due to iatrogenic factors. Only a few studies have regarded the combination of psychotropic drugs as triggers of chronic, asymptomatic hyponatremia in bipolar patients, who require to be hospitalized because of the exacerbation of their mental illness. We presented three clinical cases of patients affected by a long-term psychiatric disorder and under polypharmacotherapy for several months. After excluding other potential factors, we hypothesized that pharmacological treatment with a mood stabilizer (oxcarbazepine) associated with a benzodiazepine (delorazepam), a second-generation antipsychotic (olanzapine) or an antidepressant (fluvoxamine), triggered severe hyponatremia ([Na+] ≤125 mEq/L), serum hypo-osmolarity, and elevated inappropriate urine osmolarity added to more diluted sodium concentration. When we discontinued the treatment, clinical conditions of our patients improved, despite the previous administration of hypertonic saline jointly with water restriction. Psychiatrists should consider that bipolar patients on long-term polypharmacotherapy may present a higher risk of severe hyponatremia not clinically detectable. Consequently, routine laboratory tests should be periodically repeated as they represent the only available tool to unmask such electrolyte imbalances.

Topics: Adult; Anti-Anxiety Agents; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Female; Humans; Hyponatremia; Male; Middle Aged; Nordazepam; Olanzapine; Oxcarbazepine; Psychotropic Drugs

Topics: Adrenergic beta-Antagonists; Antipsychotic Agents; Benzodiazepines; Craniocerebral Trauma; Humans; Hyponatremia; Male; Middle Aged; Olanzapine; Polydipsia, Psychogenic; Propranolol

A man in his twenties was diagnosed with schizophrenia in his late teens. The night before his death, his family reported he drank a large amount of water, vomited, collapsed, and snored loudly while sleeping, but they did not view the event seriously as he did it routinely. The following morning, he was found dead. Autopsy revealed hyponatremia by water intoxication as the cause of death. Water intoxication has various causes. In this case, 610 ng/mL olanzapine was detected in serum samples. Although this concentration is not as high as the fatal concentrations reported in past studies, it might have caused some adverse effects. Furthermore, the observation that excessive drinking behavior started after the dose of olanzapine was increased suggests a possibility that olanzapine aggravated water intoxication.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Chlorides; Fatal Outcome; Humans; Hyponatremia; Male; Olanzapine; Potassium; Schizophrenia; Sodium; Vitreous Body; Water Intoxication

Topics: Adult; Antipsychotic Agents; Autistic Disorder; Benzodiazepines; Humans; Hyponatremia; Male; Olanzapine; Polydipsia, Psychogenic

This case report provides a different perspective on the management of a patient with a psychotic illness. The detained patient, a man aged 50, had specific delusional beliefs about toxins affecting his kidneys, such that he needed to drink water to 'detoxify' himself. This resulted in him developing life-threatening hyponatraemia. It became clear that he was very resistant to taking oral medication and was reluctant to engage with any psychological treatment. A novel approach was considered, involving the 'off licence' use of short acting intramuscular olanzapine for the successful treatment of the psychotic illness. The case demonstrates the safe use of intramuscular olanzapine for 155 days, which is the longest reported case for the use of intramuscular olanzapine for the treatment of a psychotic illness. The individual was later discharged on oral olanzapine.

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Hyponatremia; Injections, Intramuscular; Male; Middle Aged; Olanzapine; Schizophrenia, Paranoid; Severity of Illness Index; Time Factors

Topics: Antipsychotic Agents; Benzodiazepines; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Middle Aged; Nomograms; Olanzapine

To report a case of fatal hyponatremia, marked hyperglycemia, and acute pancreatitis following simultaneous administration of paroxetine, fluphenazine, haloperidol and olanzapine.. A 44-year-old non-diabetic male was admitted unconsciously, with severe hyponatremia, hyperglycemia and bradypnea. The patient had a history of long-term treatment with paroxetine, fluphenazine, haloperidol and olanzapine. Upon arrival, the plasma sodium level was 104 mmol/l, and blood glucose was 940 mg/dl. The therapy consisted of ventilatory support and intensive correction of hyponatremia and hyperglycemia. 2 hours later, hypotension and refractory cardiac arrest occurred. The autopsy disclosed severe cerebral edema as cause of death, and a modest hemorrhagic pancreatitis.. Paroxetine is a selective serotonin reuptake inhibitor which stimulates antidiuretic hormone (ADH) release and may cause the syndrome of inappropriate ADH secretion with consecutive hyponatremia. Fluphenazine and haloperidol may contribute to this syndrome. Fluphenazine, and particularly olanzapine are associated with an increased incidence ofdiabetes. Olanzapine has been reported as a risk factor for acute pancreatitis. The Naranjo probability scale was not applicable because of almost immediate lethal outcome.. Polypharmacy increases the risk of various adverse reactions. Adverse effects of paroxetine and many anti-psychotic drugs, such as hyponatremia and hyperglycemia, should be monitored periodically to prevent complications. The role of olanzapine in the etiology of acute pancreatitis remains to be evaluated.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Brain Edema; Fatal Outcome; Fluphenazine; Haloperidol; Heart Arrest; Humans; Hyperglycemia; Hyponatremia; Inappropriate ADH Syndrome; Male; Mental Disorders; Olanzapine; Pancreatitis; Paroxetine; Polypharmacy; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Drinking; Female; Humans; Hyponatremia; Olanzapine; Pirenzepine; Psychiatric Status Rating Scales; Schizophrenia, Paranoid; Schizophrenic Psychology; Sodium