Tricyclics as a possible cause of hyponatremia in psychiatric patients
Abstract
lead to impaired thiamine absorption. Patients with bipolar disorder, who constitute the major target population treated with lithium, have been noted to have a high incidence of alcohol abuse, a key etiotogical factor in Wernickeâs enceph-stniction. Her hyponatremia was corrected over a period of 2 days. Hen mental status returned to baseline as the hyponatremia resolved. She was discharged after 1 week with a serum sodium level of 138 meq/liter and mentalalopathy.In addition,be givento lith-iumâs having a direct inhibitory effect on the action of thiamine as a coenzyme, possibly through its ability to alter calcium-dependent processes (2) or through interference with the action of thiamine phosphatases in thiamine phosphorytation (3). There are a number of reports describingstatus at baseline level. Over the subsequent I 8 months take nortniptyline without furtherwithout recurrence of hyponatnemiathe patientdiuretic fromstate.titer.or confusional 133 to 136meq/of this effectuse, but no de(4, 5).While it is presumably a relatively rare case illustrates the potential for tnicyclic induce SIADH (2). In this case the effectsphenomenon, antidepressants on serumthis to sodium sodium treated of hy-REFERENCES 1. Reuler JB, Girard DE, Cooney TC: Current concepts of Wernickeâs encephalopathy. N EngI J Med 1985; 312:1035-1039 2. Mettzer HL: Lithium mechanisms in