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VOLUME 20 , ISSUE 12 ( 2016 ) > List of Articles

RESEARCH ARTICLE

Efficacy of conivaptan and hypertonic (3%) saline in treating hyponatremia due to syndrome of inappropriate antidiuretic hormone in a tertiary Intensive Care Unit

Karthik Rao, Ipe Jacob, Sridhar Reddy, Pradeep Rangappa, Rajeswari Janakiraman

Keywords : Conivaptan, hypertonic saline, hyponatremia, syndrome of inappropriate antidiuretic hormone

Citation Information : Rao K, Jacob I, Reddy S, Rangappa P, Janakiraman R. Efficacy of conivaptan and hypertonic (3%) saline in treating hyponatremia due to syndrome of inappropriate antidiuretic hormone in a tertiary Intensive Care Unit. Indian J Crit Care Med 2016; 20 (12):714-718.

DOI: 10.4103/0972-5229.195708

License: CC BY-ND 3.0

Published Online: 00-12-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Hyponatremia is one of the most common electrolyte abnormalities encountered in clinical practice and has a significant impact on morbidity and mortality in hospitalized patients. The optimal management of hyponatremia is still evolving. Over the last decade, vaptans have been increasingly used in clinical practice with promising results. Materials and Methods: The study included eighty patients with symptomatic hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH) admitted and treated in Intensive Care Unit (ICU) with either conivaptan or hypertonic (3%) saline. They were compared for time taken to achieve normal serum sodium, length of ICU and hospital stay, and adverse effects. Results: The demographic data and serum sodium levels at admission were comparable between the two groups. After initiating correction, sodium levels at 6, 12, and 24 h were similar between the two groups. However, at 48 h, patients in the conivaptan group (Group C) had higher sodium levels (133.0 ± 3.8 mEq/L) as compared to hypertonic saline group (Group HS) (128.9 ± 2.6 mEq/L), which was statistically significant (P < 0.001). The length of ICU stay was less in the Group C (3.35 ± 0.89 days) when compared with the Group HS (4.61 ± 0.91 days) (P < 0.001). There was no significant difference in mortality between the two groups. Conclusion: In patients with symptomatic hyponatremia due to SIADH, conivaptan with its \"aquaresis\" property can achieve a significantly better sodium correction, resulting in reduced ICU and hospital stay with no significant adverse effects.


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  1. Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med 2006;119 7 Suppl 1:S30-5.
  2. Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluation, and treatment of hyponatremia: Expert panel recommendations. Am J Med 2013;126 10 Suppl 1:S1-42.
  3. Oh MS, Carroll HJ. Disorders of sodium metabolism: Hypernatremia and hyponatremia. Crit Care Med 1992;20:94-103.
  4. Schwartz WB, Bennett W, Curelop S, Bartter FC. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 1957;23:529-42.
  5. Anderson RJ, Chung HM, Kluge R, Schrier RW. Hyponatremia: A prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med 1985;102:164-8.
  6. Decaux G, Musch W. Clinical laboratory evaluation of the syndrome of inappropriate secretion of antidiuretic hormone. Clin J Am Soc Nephrol 2008;3:1175-84.
  7. Verbalis JG, Zeltser D, Smith N, Barve A, Andoh M. Assessment of the efficacy and safety of intravenous conivaptan in patients with euvolaemic hyponatraemia: Subgroup analysis of a randomized, controlled study. Clin Endocrinol (Oxf) 2008;69:159-68.
  8. Decaux G, Unger J, Brimioulle S, Mockel J. Hyponatremia in the syndrome of inappropriate secretion of antidiuretic hormone. Rapid correction with urea, sodium chloride, and water restriction therapy. JAMA 1982;247:471-4.
  9. Iwasa H, Yamada T, Nakahara N, Shimabukuro H, Shinoda S, Indei I, et al. Marked effect of furosemide and hypertonic saline in the treatment of SIAD after head injury. No Shinkei Geka 1984;12:651-5.
  10. Cherrill DA, Stote RM, Birge JR, Singer I. Demeclocycline treatment in the syndrome of inappropriate antidiuretic hormone secretion. Ann Intern Med 1975;83:654-6.
  11. Soupart A, Decaux G. Therapeutic recommendations for management of severe hyponatremia: Current concepts on pathogenesis and prevention of neurologic complications. Clin Nephrol 1996;46:149-69.
  12. Norenberg MD, Leslie KO, Robertson AS. Association between rise in serum sodium and central pontine myelinolysis. Ann Neurol 1982;11:128-35.
  13. Velez JC, Dopson SJ, Sanders DS, Delay TA, Arthur JM. Intravenous conivaptan for the treatment of hyponatraemia caused by the syndrome of inappropriate secretion of antidiuretic hormone in hospitalized patients: A single-centre experience. Nephrol Dial Transplant 2010;25:1524-31.
  14. Zeltser D, Rosansky S, van Rensburg H, Verbalis JG, Smith N; Conivaptan Study Group. Assessment of the efficacy and safety of intravenous conivaptan in euvolemic and hypervolemic hyponatremia. Am J Nephrol 2007;27:447-57.
  15. Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med 2000;342:1581-9.
  16. Goldstein CS, Braunstein S, Goldfarb S. Idiopathic syndrome of inappropriate antidiuretic hormone secretion possibly related to advanced age. Ann Intern Med 1983;99:185-8.
  17. Miller M, Hecker MS, Friedlander DA, Carter JM. Apparent idiopathic hyponatremia in an ambulatory geriatric population. J Am Geriatr Soc 1996;44:404-8.
  18. Rose BD, Post TW. Clinical Physiology of Acid Base and Electrolyte Disorders. 15 th ed. New York: McGraw-Hill; 2001. p. 729.
  19. Dominguez M, Perez JA, Patel CB. Efficacy of 3% saline vs. conivaptan in achieving hyponatremia treatment goals. Methodist Debakey Cardiovasc J 2013;9:49-53.
  20. Koren MJ, Hamad A, Klasen S, Abeyratne A, McNutt BE, Kalra S. Efficacy and safety of 30-minute infusions of conivaptan in euvolemic and hypervolemic hyponatremia. Am J Health Syst Pharm 2011;68:818-27.
  21. Metzger BL, DeVita MV, Michelis MF. Observations regarding the use of the aquaretic agent conivaptan for treatment of hyponatremia. Int Urol Nephrol 2008;40:725-30.
  22. Wright WL, Asbury WH, Gilmore JL, Samuels OB. Conivaptan for hyponatremia in the neurocritical care unit. Neurocrit Care 2009;11:6-13.
  23. Sterns RH, Riggs JE, Schochet SS Jr. Osmotic demyelination syndrome following correction of hyponatremia. N Engl J Med 1986;314:1535-42.
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