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A 77-year-old woman developed acute symptomatic hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH) following the concomitant administration of duloxetine, warfarin and zolpidem [not all routes and dosages stated; therapeutic indications not specified].
The woman, who had underlying deep vein thrombosis, hypertension, hyperlipidaemia and anxiety, presented to hospital due to headaches and nausea. Upon an anamnesis, it was found that she had been receiving warfarin 3.5mg daily and zolpidem 5mg daily along with various other concomitant medications prior to admission. Additionally, she had received ethyl loflazepate as prescribed by her psychiatrist. The day before her presentation, her psychiatrist prescribed her duloxetine and stopped ethyl loflazepate to prevent worsening anxiety. She received a single oral dose of duloxetine in the morning and approximately 12 hours after starting duloxetine she presented with headaches and nausea. On presentation, her systolic BP was found to be 170mm Hg and serum sodium level was found to be 135 mEq/L. She received an unspecified calcium channel blocker, and...