Hypoglycemic coma is a serious and not an uncommon problem among elderly patients with diabetes mellitus and treated with insulin and/or oral hypoglycemic drugs. Risk factors contribute substantially to the morbidity and mortality of patients with drug-induced hypoglycemic coma. Enhanced therapeutic monitoring may be warranted when hypoglycemic drugs are administered to an elderly patient with the above predisposing factors and potentiating drugs for hypoglycemia.

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LEITERS TO THE EDITOR ' 631patients when the treatment is continued under fluid restriction. Age is probably not an independent factor in SSRIinduced SIADH, but other co-factors, such as pluripathology, polymedication, and/or malnutrition, may explain the higher incidence in this age group. Other prospective studies are now necessary to determine whether and how cofactors influence the onset and the severity of SSRI-induced hyponatremia. C. Christe, Pharm D N. Vogt, MD University Hospital of Geneva, Switzerland REFERENCES 1. Skcritt U, Evans R, Montgonicry SA. Selectivc serotonin reuptake inhibitors in oldcr patients. Drugs Aging 1997;10:209-218. 2. Pillans PI, Coulter DM. Fluoxctine and hyponatremia: A potential liazard in the elderly. N 2 Med J 1994;107:85-86. 3. Liu BA, Mittmann N, Knowlcs SR, Shear NH. Hyponatrcmia and the syndrome of inappropriate secretion of antidiuretic hormone associatcd with the usc of selectivc serotonin reuptake inhibitors: Areview of spontaneous rcports. Can Med Assoc J 19963155519527. 4. Bouman WP, Pinner G, Johnson H. Incidence of sclcctive serotonin reuptake inhibitor (SSR1)-induced hyponatreniia due to the syndrome of inappropriate antidiuretic hormonc (SIADH) sccrction in the elderly. Int J Gcriatr Psychiatry 1998;13:12-15.