Sodium Oxybate induces involuntary weight loss in young female- Case study

Dr Michael Noujaim at Department of Medicine, Duke University Medical Center, Durham, NC, USA and colleagues have reported a rare case of extreme involuntary weight loss in a young female after taking sodium Oxybate. The case has appeared in the Case Reports in Medicine.

Sodium oxybate (SXB) is a central nervous system depressant that primarily acts as a GABA_B receptor agonist. Sodium oxybate was approved in 2002 for the treatment of excessive daytime sleepiness and cataplexy in patients with narcolepsy in the United States. Its reported adverse effects include some weight loss (<12%) and depression (3–6%).

A 27-year-old female came to our primary care clinic with 64-pound unintentional weight loss over a 10-month period. Her associated symptoms included drenching night sweats, depressed mood, a lack of interest in performing her daily activities, and decreased energy. Her medical history was significant for the polycystic ovarian syndrome, dysmenorrhea, and type 1 narcolepsy with hypnagogic/hypnopompic hallucinations and cataplexy. She had been followed by neurology long term for narcolepsy and was initially treated with methylphenidate (120 milligrams daily), subsequently transitioned to SXB (9 grams daily)—given its higher efficacy—approximately 10 months prior to her presentation.

During this period, she endorsed eating her baseline three meals a day. She was not exercising at all and was losing weight on a daily basis. She weighed 205 pounds at the onset of her symptoms and weighed 142 pounds on the current presentation. The patient denied any gastrointestinal symptoms including nausea, vomiting, or diarrhea. Her in-clinic PHQ-9 score was 9 points. The rest of her physical exam was notable for no palpable lymphadenopathy, a normal head, heart, chest, skin, and abdominal exam. She had had a recent normal pelvic exam and a normal pap smear from the prior year.

Given our patient’s unexplained weight loss and constitutional symptoms, an extensive workup was performed that included computed tomography scans of her chest, abdomen, and pelvis, complete blood count, comprehensive metabolic panel, thyroid profile, anti-nuclear antibody screen, C-reactive protein, sedimentation rate, lactate dehydrogenase, urinalysis, and peripheral blood smear. All of her laboratory testing and imaging studies were normal. Given negative testing and the temporal association of her symptoms with starting SXB, we decided to hold her SXB and scheduled follow-up at 3-week intervals. On initial follow-up, the patient’s night sweats and depressive symptoms had resolved, and for the first time in almost a year, she had not lost any weight but instead had gained 3 pounds.

For further reference log on to: https://doi.org/10.1155/2019/6537815