Severe hyponatremia and hypokalemia associated to the use of hydrochlorothiazide, enalapril and cytalopram. Report of one case

We report a 72 years old hypertensive female, treated with enalapril 10 mg/ day and hydrochlorothiazide 25 mg/day during three years. She presented a d epressive disorder and cytalopram was prescribed In a dose of 10 mg/day. Tw o weeks before admission, a serum electrolyte analysis disclosed normal res ults and the cytalopram dose was increased to 20 mg/day. The patient was ad mitted with a hyponatremic encephalopathy with a plasma sodium of 100 mEq/L and a plasma potassium of 2.0 mEq/L. Cytalopram, enalapril and hydrochloro thiazide were discontinued, hypertonic NaCl and KCl were administered. The patient had a favorable evolution with a remarkable improvement of her symp toms.