Syndrome of inappropriate antidiuretic hormone secretion caused by long-term use of sodium valproate： a case report and literature review

Abstract

Objective To explore the pathogenesis, diagnosis and treatment of syndrome of inappropriate secretion of antidiuretic hormone （SIADH） caused by sodium valproate （VPA）, aiming to improve the awareness of clinicians. Methods Clinical data of a patient with SIADH caused by long-term use of VPA were collected. Literature review was conducted by using the keywords of “VPA” and “SIADH” in both Chinese and English from PubMed and CNKI databases. Results The 62-year-old male patient presented with malaise, lower extremity edema, and hyponatremia as the main manifestations. He was administered with VPA for a long-time due to the secondary epilepsy. The diagnosis of SIADH caused by VPA was confirmed after excluding other possible causes of hyponatremia. After stopping VPA and adding tolvaptanka, serum sodium gradually returned to normal range. During follow-up, the patient’s symptoms were improved, and the serum sodium was normal. Through literature reviews, a total of 5 related case reports consisting of 8 patients were retrieved and 6 of them were middle-aged and elderly patients. Symptoms of all patients were improved after gradually discontinuing use of VPA. Conclusions The cases of SIADH caused by use of VPA have been rarely reported in clinical practice, which are likely to be missed diagnosis or misdiagnosed. This case prompts that when SIADH is considered in the diagnosis of refractory hyponatremia, attention should be paid to the possibility that SIADH may be caused by use of VPA. Hence, the treatment plan should be timely adjusted to mitigate symptoms and enhance prognosis of patients.

Keywords

• |sodium valproate|syndrome of inappropriate antidiuretic hormone secretion|hyponatremia