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Case Report: SIADH-Induced Hyponatremia Following Sertraline and Quetiapine Use in an Elderly Patient with Dementia: A Case Report
Khorshid R, Binyamin M, Alsalem M.. F1000Res, 2026-06-18
Topic: Drug trials: efficacy and safety
Background: Hyponatremia — defined as serum sodium below 135 mEq/L — is the most common electrolyte disturbance in hospitalised patients and can be precipitated by psychotropic medications through the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Selective serotonin reuptake inhibitors (SSRIs) are a well-recognised cause, while second-generation antipsychotics such as quetiapine have been implicated less frequently. Cases involving the concurrent use of both drug classes in elderly patients with dementia are rarely reported. Case presentation We describe a 77-year-old man with advanced Alzheimer’s disease, type 2 diabetes, hypertension, chronic kidney disease, and multiple other comorbidities who developed severe hyponatremia (serum sodium 121 mmol/L) following concurrent treatment with sertraline 50 mg and quetiapine. He presented with worsening dyspnoea and an abrupt decline in cognition over two months, temporally associated with the reintroduction of quetiapine. Laboratory findings confirmed hypotonic hyponatremia with inappropriately concentrated urine, consistent with SIADH. Thyroid and adrenal function were normal. Cardiac evaluation revealed new-onset heart failure without an acute ischaemic event. After systematic exclusion of other aetiologies, psychotropic medications were identified as the probable cause. Management comprised discontinuation of both sertraline and quetiapine and fluid restriction to less than 1,000 mL per day, with close electrolyte monitoring. Conclusion This case underscores the importance of routine sodium monitoring in elderly patients with dementia initiated on serotonergic or antipsychotic therapy. Acute cognitive deterioration in this population should prompt evaluation for reversible metabolic causes, including drug-induced hyponatremia, before attributing decline to dementia progression. A multidisciplinary approach involving neurology, nephrology, and psychiatry is essential for accurate diagnosis and safe management.
Key findings
- He presented with worsening dyspnoea and an abrupt decline in cognition over two months, temporally associated with the reintroduction of quetiapine.
- Cardiac evaluation revealed new-onset heart failure without an acute ischaemic event.
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Study details
- Evidence strengthLow
How this study scored 41/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 24 of the 58 points we could judge it on, which is 41 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (F1000Res) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 24 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 24 of the 58 points we could judge it on is 41 out of 100. |
| Total | 41 / 100 | — |
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APA 7th
Khorshid, R., Binyamin, M., & Alsalem, M. (2026). Case Report: SIADH-Induced Hyponatremia Following Sertraline and Quetiapine Use in an Elderly Patient with Dementia: A Case Report. F1000Res. https://doi.org/10.12688/f1000research.182914.1
Vancouver
Khorshid R, Binyamin M, Alsalem M. Case Report: SIADH-Induced Hyponatremia Following Sertraline and Quetiapine Use in an Elderly Patient with Dementia: A Case Report. F1000Res. 2026. doi:10.12688/f1000research.182914.1.
BibTeX
@article{khorshid2026-2ca036da,
author = {Khorshid, R. and Binyamin, M. and Alsalem, M.},
title = {{Case Report: SIADH-Induced Hyponatremia Following Sertraline and Quetiapine Use in an Elderly Patient with Dementia: A Case Report}},
journal = {F1000Res},
year = {2026},
doi = {10.12688/f1000research.182914.1},
url = {https://doi.org/10.12688/f1000research.182914.1}
}
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