Unpredictable Nature of Tolvaptan in Treatment of Hypervolemic Hyponatremia: Case Review on Role of Vaptans
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 etiolog...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2014/807054 |
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| author | Ishan Malhotra Shilpa Gopinath Kalyana C. Janga Sheldon Greenberg Shree K. Sharma Regina Tarkovsky |
| author_facet | Ishan Malhotra Shilpa Gopinath Kalyana C. Janga Sheldon Greenberg Shree K. Sharma Regina Tarkovsky |
| author_sort | Ishan Malhotra |
| collection | DOAJ |
| description | 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). |
| format | Article |
| id | doaj-art-830bbf8bd11d454cbe60076f169ec83a |
| institution | OA Journals |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-830bbf8bd11d454cbe60076f169ec83a2025-08-20T02:08:46ZengWileyCase Reports in Endocrinology2090-65012090-651X2014-01-01201410.1155/2014/807054807054Unpredictable Nature of Tolvaptan in Treatment of Hypervolemic Hyponatremia: Case Review on Role of VaptansIshan Malhotra0Shilpa Gopinath1Kalyana C. Janga2Sheldon Greenberg3Shree K. Sharma4Regina Tarkovsky5Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USADepartment of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USADepartment of Nephrology, Maimonides Medical Center, 953 49th Street, Brooklyn, NY 11219, USADepartment of Nephrology, Maimonides Medical Center, 953 49th Street, Brooklyn, NY 11219, USADepartment of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USADepartment of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USAHyponatremia 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).http://dx.doi.org/10.1155/2014/807054 |
| spellingShingle | Ishan Malhotra Shilpa Gopinath Kalyana C. Janga Sheldon Greenberg Shree K. Sharma Regina Tarkovsky Unpredictable Nature of Tolvaptan in Treatment of Hypervolemic Hyponatremia: Case Review on Role of Vaptans Case Reports in Endocrinology |
| title | Unpredictable Nature of Tolvaptan in Treatment of Hypervolemic Hyponatremia: Case Review on Role of Vaptans |
| title_full | Unpredictable Nature of Tolvaptan in Treatment of Hypervolemic Hyponatremia: Case Review on Role of Vaptans |
| title_fullStr | Unpredictable Nature of Tolvaptan in Treatment of Hypervolemic Hyponatremia: Case Review on Role of Vaptans |
| title_full_unstemmed | Unpredictable Nature of Tolvaptan in Treatment of Hypervolemic Hyponatremia: Case Review on Role of Vaptans |
| title_short | Unpredictable Nature of Tolvaptan in Treatment of Hypervolemic Hyponatremia: Case Review on Role of Vaptans |
| title_sort | unpredictable nature of tolvaptan in treatment of hypervolemic hyponatremia case review on role of vaptans |
| url | http://dx.doi.org/10.1155/2014/807054 |
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