Abstracts
3427231
(#14) Severe Hyponatremia Following Risperidone Initiation in an Elderly Woman With Chronic Kidney Disease: A Case Report
Abstract: Objective: Psychotropic-associated hyponatremia is often attributed to syndrome of inappropriate antidiuretic hormone secretion, but atypical presentations can complicate diagnosis and management.
Methods: We report a 77-year-old woman with bipolar I disorder and stage III chronic kidney disease who developed acute symptomatic hyponatremia soon after switching from aripiprazole to risperidone.
Results: Seven days after risperidone initiation, she developed lethargy, confusion, nausea, vomiting, and diarrhea. Laboratory testing showed serum sodium 118 mmol/L, serum osmolality 257 mOsm/kg, urine osmolality 160 mOsm/kg, and urine sodium 20 mmol/L. Although risperidone-associated syndrome of inappropriate antidiuretic hormone secretion was initially a concern, the low urine sodium and concurrent gastrointestinal losses suggested hypovolemic hyponatremia with a possible mixed mechanism. Risperidone was discontinued, and she was treated with cautious 3% hypertonic saline, oral salt tablets, and 1 L/day fluid restriction. Sodium normalized to 136 mmol/L within 6 days, and mental status returned to baseline.
Conclusions: This case illustrates that risperidone-associated hyponatremia may not follow classic syndrome of inappropriate antidiuretic hormone secretion patterns. In older patients with medical comorbidity, urine electrolytes, volume status, and gastrointestinal losses should guide interpretation and management.
Short Description: This poster presents a case of severe hyponatremia developing within one week of risperidone initiation in an older woman with chronic kidney disease. It highlights how low urine sodium and concurrent gastrointestinal losses shifted the differential away from classic syndrome of inappropriate antidiuretic hormone secretion and changed management.
Name of Sponsoring Organization(s): N/A
Methods: We report a 77-year-old woman with bipolar I disorder and stage III chronic kidney disease who developed acute symptomatic hyponatremia soon after switching from aripiprazole to risperidone.
Results: Seven days after risperidone initiation, she developed lethargy, confusion, nausea, vomiting, and diarrhea. Laboratory testing showed serum sodium 118 mmol/L, serum osmolality 257 mOsm/kg, urine osmolality 160 mOsm/kg, and urine sodium 20 mmol/L. Although risperidone-associated syndrome of inappropriate antidiuretic hormone secretion was initially a concern, the low urine sodium and concurrent gastrointestinal losses suggested hypovolemic hyponatremia with a possible mixed mechanism. Risperidone was discontinued, and she was treated with cautious 3% hypertonic saline, oral salt tablets, and 1 L/day fluid restriction. Sodium normalized to 136 mmol/L within 6 days, and mental status returned to baseline.
Conclusions: This case illustrates that risperidone-associated hyponatremia may not follow classic syndrome of inappropriate antidiuretic hormone secretion patterns. In older patients with medical comorbidity, urine electrolytes, volume status, and gastrointestinal losses should guide interpretation and management.
Short Description: This poster presents a case of severe hyponatremia developing within one week of risperidone initiation in an older woman with chronic kidney disease. It highlights how low urine sodium and concurrent gastrointestinal losses shifted the differential away from classic syndrome of inappropriate antidiuretic hormone secretion and changed management.
Name of Sponsoring Organization(s): N/A
