Escitalopram induced syndrome of inappropriate antidiuretic hormone in elderly: an interesting scenario

Selective serotonin reuptake inhibitors (SSRI) are the first line drugs used in the treatment of endogenous depression. Though clinically well tolerated in elderly, hyponatremia is one of the recognized side effects and its pathophysiology may be linked to syndrome of inappropriate antidiuretic hormone (SIADH). This side effect of SSRIs is a serious one since it can cause death also, if not diagnosed at the onset.  This is an interesting case of an elderly patient who developed hyponatremia which further related to SIADH induced by escitalopram, an SSRI.  The patient had symptomatic improvement in depression within one month but symptoms of hyponatremia appeared and then deteriorated again. Severe hyponatremia, serum hypo-osmolality, urine osmolality, and measurable levels of plasma antidiuretic hormone suggested SIADH. The hyponatremia improved after stoppage of the offending drug along with conservative medical therapy in hospital.  Clinicians should be aware of this uncommon but significant side effect of escitalopram and monitor high-risk patients for the development of SIADH

A study of factors influencing decisions on organ donation among patient attendees in a Tertiary Care Hospital in North India

Introduction: Organ transplantation is the most preferred treatment modality for end-stage organ disease and organ failures as it improves the quality of life. Patients deemed fit for transplantation by the transplant team often wait expectantly for a donor organ. Each year thousands of individuals wait for organs to be donated for transplantation. There remains, therefore, a great need for increasing organ donation and harnessing of donor organs. Aims and Objectives: To determine knowledge, attitude, and practices of the general population for organ donation. To determine the factors which facilitate or inhibit general population from organ donation. Methodology: A cross-sectional survey was conducted among a total of 120 patient attendants attending outpatient department in the age group of 18–65 years at Sir Ganga Ram Hospital, New Delhi. Results: One hundred and twenty participants were enrolled in the study, but only 119 participated. The mean age of males was 37.7 ± 14.7 years while that of females was 32.7 ± 11.5. Maximum awareness was found to be for kidney donation, least awareness for ear drums, and intestine donation. About 49.1% males and 51.6% females were aware of the legislation related to organ transplantation. The majority of female respondents (73.3%) showed their willingness to donate their organs in contrast to males only 16.7% were ready to donate in any situation. Females (60.7%) outnumbered males (45.8%) in their readiness to sign an organ donor card. About 73.3% females and 64.4% males were ready to participate in any promotion campaign related to organ donation. Conclusion: The magnitude of organ retrieval for the execution of a successful donor program is heavily dependent upon the level of knowledge and attitudes of the general public, so the need of hour is to increase the awareness among masses

Agreement between international classification of disease (ICD) and cause of death and associated conditions (CODAC) for the ascertainment of cause of stillbirth (SB) in the rural areas of north India

International Classification of Diseases-10 th version (ICD-10) has been used to ascertain the cause of death but its use for stillbirths (SBs) is limited. Cause of Death and Associated Conditions (CODAC) as a detailed system expected to provide the exact cause of SB, so a community-based study was planned to study the level of agreement between ICD-10 and CODAC for ascertaining the cause of SB. A verbal autopsy (VA) tool was used to collect the information and then the cause of each SB was assigned using ICD-10 and CODAC separately. Each tool was used for 87 SBs and found that prolonged singleton labor, maternal pregnancy induced hypertension (PIH), and central nervous system (CNS) related congenital malformations were considered the top three causes. There was a significant agreement between ICD-10 and CODAC but the latter offers a scope to delineate the causes more precisely due to its hierarchal nature

Escitalopram induced syndrome of inappropriate antidiuretic hormone in elderly: an interesting scenario

Selective serotonin reuptake inhibitors (SSRI) are the first line drugs used in the treatment of endogenous depression. Though clinically well tolerated in elderly, hyponatremia is one of the recognized side effects and its pathophysiology may be linked to syndrome of inappropriate antidiuretic hormone (SIADH). This side effect of SSRIs is a serious one since it can cause death also, if not diagnosed at the onset.  This is an interesting case of an elderly patient who developed hyponatremia which further related to SIADH induced by escitalopram, an SSRI.  The patient had symptomatic improvement in depression within one month but symptoms of hyponatremia appeared and then deteriorated again. Severe hyponatremia, serum hypo-osmolality, urine osmolality, and measurable levels of plasma antidiuretic hormone suggested SIADH. The hyponatremia improved after stoppage of the offending drug along with conservative medical therapy in hospital.  Clinicians should be aware of this uncommon but significant side effect of escitalopram and monitor high-risk patients for the development of SIADH