Unpredictable nature of tolvaptan in treatment of hypervolemic hyponatremia: case review on role of vaptans.
Ishan Malhotra,Shilpa Gopinath,Kalyana C. Janga,Sheldon Greenberg,Shree K. Sharma,Regina Tarkovsky +5 more
TLDR
The following case report analyzes the role of vasopressin antagonists in the treatment of hyponatremia and the need for daily dosing of tolvaptan and the monitoring of serum sodium levels to avoid rapid overcorrection which can result in osmotic demyelination syndrome (ODS).Abstract:
Hyponatremia is one of the most commonly encountered electrolyte abnormalities occurring in up to 22% of hospitalized patients. Hyponatremia usually reflects excess water retention relative to sodium rather than sodium deficiency. Volume status and serum osmolality are essential to determine etiology. Treatment depends on several factors, including the cause, overall volume status of the patient, severity of hyponatremic symptoms, and duration of hyponatremia at presentation. Vasopressin antagonists like tolvaptan seem promising for the treatment of euvolemic and hypervolemic hyponatremia in heart failure. Low sodium concentrations cause cerebral edema, but the overly rapid sodium correction can also lead to iatrogenic cerebral osmotic demyelination syndrome. Demyelination may occur days after sodium correction or initial neurologic recovery from hyponatremia. The following case report analyzes the role of vasopressin antagonists in the treatment of hyponatremia and the need for daily dosing of tolvaptan and the monitoring of serum sodium levels to avoid rapid overcorrection which can result in osmotic demyelination syndrome (ODS).read more
Citations
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Davidson's Principles and Practice of Medicine
TL;DR: The present editors have kept up-to-date and been prepared to prune the dead wood, and the book is economical in price and compact in size, but still contains the essential truths for the practice of good medicine.
Journal ArticleDOI
Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines.
Ewout J. Hoorn,Robert Zietse +1 more
TL;DR: The diagnosis and treatment of hyponatremia is discussed, comparing the two guidelines and highlighting recent developments, including fractional uric acid excretion and plasma copeptin concentration, which may further improve the diagnostic approach.
Journal ArticleDOI
Current treatment practice and outcomes. Report of the hyponatremia registry
Arthur Greenberg,Joseph G. Verbalis,Alpesh Amin,Volker Burst,Joseph Chiodo,Jun R. Chiong,Joseph F. Dasta,Keith Friend,Paul J. Hauptman,Alessandro Peri,Samuel H. Sigal +10 more
TL;DR: Initial HN treatment often uses maneuvers of limited efficacy, and most patients with HN are discharged from hospital still hyponatremic, so studies to assess short- and long-term benefits of correction of HN with effective therapies are needed.
Journal ArticleDOI
Diagnosing and Treating the Syndrome of Inappropriate Antidiuretic Hormone Secretion
Joseph G. Verbalis,Arthur Greenberg,Volker Burst,Jean-Philippe Haymann,Gudmundur Johannsson,Alessandro Peri,Esteban Poch,Joseph Chiodo,Jiten Dave +8 more
TL;DR: Current treatment of hyponatremia in syndrome of inappropriate antidiuretic hormone secretion often uses therapies with limited efficacy; the most commonly chosen monotherapy treatments, fluid restriction and isotonic saline, failed to increase the serum [Na(+)] by ≥5 mEq/L in 55% and 64% of monotherapy treatment episodes, respectively.
Journal ArticleDOI
Hyponatremia and the Brain.
Fabrice Gankam Kengne,Guy Decaux +1 more
TL;DR: The brain can be affected by the treatment of hyponatremia, which, if not undertaken cautiously, could lead to osmotic demyelination syndrome, a rare demYelinating brain disorder that occurs after rapid correction of severe hypon atremia.
References
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Diuretic Strategies in Patients with Acute Decompensated Heart Failure
G. Michael Felker,Kerry L. Lee,David A. Bull,Margaret M. Redfield,Lynne W. Stevenson,Steven R. Goldsmith,Martin M. LeWinter,Anita Deswal,Jean L. Rouleau,Elizabeth Ofili,Kevin J. Anstrom,Adrian F. Hernandez,Steven McNulty,Eric J. Velazquez,Abdallah G. Kfoury,Horng H. Chen,Michael M. Givertz,Marc J. Semigran,Bradley A. Bart,Alice M. Mascette,Eugene Braunwald,Christopher M. O'Connor +21 more
TL;DR: Among patients with acute decompensated heart failure, there were no significant differences in patients' global assessment of symptoms or in the change in renal function when diuretic therapy was administered by bolus as compared with continuous infusion or at a high dose asCompared with a low dose.
Journal ArticleDOI
Davidson's Principles and Practice of Medicine
TL;DR: The present editors have kept up-to-date and been prepared to prune the dead wood, and the book is economical in price and compact in size, but still contains the essential truths for the practice of good medicine.
Book
Davidson's Principles and Practice of Medicine
Stanley Davidson,C Haslett +1 more
TL;DR: Part 1 - Principles of medicine .
Journal ArticleDOI
The vasopressin V1b receptor critically regulates hypothalamic-pituitary-adrenal axis activity under both stress and resting conditions
Akito Tanoue,Shuji Ito,Kenji Honda,Sayuri Oshikawa,Yoko Kitagawa,Taka-aki Koshimizu,Toyoki Mori,Gozoh Tsujimoto +7 more
TL;DR: The results clearly demonstrate that the V1b receptor plays a crucial role in regulating hypothalamic-pituitary-adrenal axis activity by maintaining ACTH and corticosterone levels, not only under stress but also under basal conditions.