Fatal hyponatremia and other metabolic disturbances associated with psychotropic drug polypharmacy.
OBJECTIVE
To report a case of fatal hyponatremia, marked hyperglycemia, and acute pancreatitis following simultaneous administration of paroxetine, fluphenazine, haloperidol and olanzapine.


METHODS
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.


CONCLUSIONS
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.


CONCLUSIONS
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.
Vucicevic
Z
Z
Department of Emergency Medicine, University Department of Medicine, Sestre milosrdnice University Hospital, Zagreb, Croatia. zeljko.vucicevic@zg.t-com.hr
Degoricija
V
V
Alfirevic
Z
Z
Vukicevic-Badouin
D
D
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects; D001929:Brain Edema / Q000139:chemically induced*; D017809:Fatal Outcome; D005476:Fluphenazine / Q000009:adverse effects; D006220:Haloperidol / Q000009:adverse effects; D006323:Heart Arrest / Q000139:chemically induced; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D007010:Hyponatremia / Q000139:chemically induced*; D007177:Inappropriate ADH Syndrome / Q000139:chemically induced; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D000077152:Olanzapine; D010195:Pancreatitis / Q000139:chemically induced; D017374:Paroxetine / Q000009:adverse effects; D019338:Polypharmacy; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D005476:Fluphenazine; D006220:Haloperidol; D000077152:Olanzapine; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors