Work

SUN-004 Benzodiazepine Withdrawal Leading To Syndrome of Inappropriate Antidiuresis (SIAD)

Year: 2024

Type: article

Abstract: A. Iqbal: None. A. Sridhar: None. R. Kaur: None. T. Chaudhary: None. F. Haider: None. M. Dominic: None. B.K. Ray: None. M. Syed: None. E. Mcfadden: None. Introduction: The Syndrome of Inappropriate Antidiuresis (SIAD), formerly known as the syndrome of inappropriate antidiuretic hormone secretion, is a condition marked by abnormal water retention due to non-osmotic factors. Frequent causes include central nervous system issues, cancer, medications, pulmonary diseases, hormonal imbalances, and HIV. Diagnostic criteria for SIAD according to AACE guidelines encompass low serum osmolality (<275 mOsmol/kgH2O), high urine osmolality (>100 mOsmol/kgH2O), clinical euvolemia, increased urinary sodium (>30mmol/L) with normal dietary intake of salt and water, no other causes for euvolemic hypo-osmolality, intact renal function, and no diuretic usage. This report details the case of a 75-year-old female with a history of chronic anxiety, who developed hyponatremia after running out of her Lorazepam medication. Case Presentation: A 75-year-old woman with a background of chronic anxiety, hypertension, and hyperlipidemia presented with left-sided facial weakness and a history of chronic pain, for which she was using Percocet. She was enrolled in a detoxification program due to Percocet overuse. Earlier in the day, she tested negative for Benzodiazepines at her primary care physician's office. The patient, habitually taking more Lorazepam than prescribed for anxiety, ran out of her medication, leading to her current symptoms, including a pulling sensation on the left side of her face. No other active complaints or signs of fluid overload were noted. Laboratory tests revealed significant findings: corrected sodium at 121 mmol/L, potassium at 3.3 mmol/L, magnesium at 1.8 mmol/L, urine osmolality at 195mOsmol/kgH2O, urinary sodium excretion at 36mmol/L, and serum osmolality at 255 mOsm/kgH2O. Thyroid functions were normal. Treatment with 0.9% NaCl intravenously normalized her sodium levels. She was discharged after two days with sodium levels at 134 mmol/L and prescribed sodium chloride tablets (1 gram twice daily) for three days. At a follow-up visit, her sodium levels were stable at 135 mmol/L. Conclusion: This case illuminates the critical connection between benzodiazepine withdrawal and the development of Syndrome of Inappropriate Antidiuresis (SIAD). It emphasizes the necessity for clinicians to recognize the potential impact of abrupt discontinuation of benzodiazepines, particularly in patients with long-term use for conditions like anxiety. It also highlights the need for gradual tapering of benzodiazepines and close observation during withdrawal to prevent such complications. Sunday, June 2, 2024

Source: Journal of the Endocrine Society

DOI: 10.1210/jendso/bvae163.2403