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Management of SIADH-related hyponatremia due to psychotropic medications - An expert consensus from the Association of Medicine and Psychiatry.

Publication ,  Journal Article
Pinkhasov, A; Xiong, G; Bourgeois, JA; Heinrich, TW; Huang, H; Coriolan, S; Annamalai, A; Mangal, JP; Frankel, S; Lang, M; Raj, YP; Dandois, M ...
Published in: J Psychosom Res
December 2021

OBJECTIVE: Hyponatremia is the most common electrolyte imbalance encountered in clinical practice and is associated with negative healthcare outcomes and cost. SIADH is thought to account for one third of all hyponatremia cases and is typically an insidious process. Psychotropic medications are commonly implicated in the etiology of drug induced SIADH. There is limited guidance for clinicians on management of psychotropic-induced SIADH. METHODS: After an extensive review of the existing literature, clinical-educators from the Association of Medicine and Psychiatry developed expert consensus recommendations for management of psychotropic-induced SIADH. A risk score was proposed based on risk factors for SIADH to guide clinical decision-making. RESULTS: SSRIs, SNRIs, antipsychotics, carbamazepine, and oxcarbazepine have moderate to high level of evidence demonstrating their association with SIADH. Evaluation for an avoidance of medications that cause hyponatremia is particularly important. Substitution with medication that is less likely to cause SIADH should be considered when appropriate. We propose an algorithmic approach to monitoring hyponatremia with SIADH and corresponding treatment depending on symptom severity. CONCLUSIONS: The proposed algorithm can help clinicians in determining whether psychotropic medication should be stopped, reduced or substituted where SIADH is suspected with recommendations for sodium (Na+) monitoring. These recommendations preserve a role for clinical judgment in the management of hyponatremia with consideration of the risks and benefits, which may be particularly relevant for complex patients that present with medical and psychiatric comorbidities. Further studies are needed to determine whether baseline and serial Na+ monitoring reduces morbidity and mortality.

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Published In

J Psychosom Res

DOI

EISSN

1879-1360

Publication Date

December 2021

Volume

151

Start / End Page

110654

Location

England

Related Subject Headings

  • Psychotropic Drugs
  • Psychiatry
  • Psychiatry
  • Inappropriate ADH Syndrome
  • Hyponatremia
  • Humans
  • Consensus
  • 5203 Clinical and health psychology
  • 5202 Biological psychology
  • 17 Psychology and Cognitive Sciences
 

Citation

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ICMJE
MLA
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Pinkhasov, A., Xiong, G., Bourgeois, J. A., Heinrich, T. W., Huang, H., Coriolan, S., … Fiedorowicz, J. G. (2021). Management of SIADH-related hyponatremia due to psychotropic medications - An expert consensus from the Association of Medicine and Psychiatry. J Psychosom Res, 151, 110654. https://doi.org/10.1016/j.jpsychores.2021.110654
Pinkhasov, Aaron, Glen Xiong, James A. Bourgeois, Thomas W. Heinrich, Heather Huang, Shanice Coriolan, Aniyizhai Annamalai, et al. “Management of SIADH-related hyponatremia due to psychotropic medications - An expert consensus from the Association of Medicine and Psychiatry.J Psychosom Res 151 (December 2021): 110654. https://doi.org/10.1016/j.jpsychores.2021.110654.
Pinkhasov A, Xiong G, Bourgeois JA, Heinrich TW, Huang H, Coriolan S, et al. Management of SIADH-related hyponatremia due to psychotropic medications - An expert consensus from the Association of Medicine and Psychiatry. J Psychosom Res. 2021 Dec;151:110654.
Pinkhasov, Aaron, et al. “Management of SIADH-related hyponatremia due to psychotropic medications - An expert consensus from the Association of Medicine and Psychiatry.J Psychosom Res, vol. 151, Dec. 2021, p. 110654. Pubmed, doi:10.1016/j.jpsychores.2021.110654.
Pinkhasov A, Xiong G, Bourgeois JA, Heinrich TW, Huang H, Coriolan S, Annamalai A, Mangal JP, Frankel S, Lang M, Raj YP, Dandois M, Barth K, Stewart AL, Rado J, Pesek J, Sanders A, Spearman-McCarthy EV, Gagliardi J, Fiedorowicz JG. Management of SIADH-related hyponatremia due to psychotropic medications - An expert consensus from the Association of Medicine and Psychiatry. J Psychosom Res. 2021 Dec;151:110654.
Journal cover image

Published In

J Psychosom Res

DOI

EISSN

1879-1360

Publication Date

December 2021

Volume

151

Start / End Page

110654

Location

England

Related Subject Headings

  • Psychotropic Drugs
  • Psychiatry
  • Psychiatry
  • Inappropriate ADH Syndrome
  • Hyponatremia
  • Humans
  • Consensus
  • 5203 Clinical and health psychology
  • 5202 Biological psychology
  • 17 Psychology and Cognitive Sciences