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https://www.readbyqxmd.com/read/28295447/effectiveness-and-tolerability-of-conivaptan-and-tolvaptan-for-the-treatment-of-hyponatremia-in-neurocritically-ill-patients
#1
Caroline Der-Nigoghossian, Christine Lesch, Karen Berger
STUDY OBJECTIVE: To describe the effectiveness and tolerability of conivaptan and tolvaptan for the correction of hyponatremia in neurocritically ill patients. DESIGN: Retrospective cohort study. SETTING: Neurointensive care units at two academic medical centers. PATIENTS: Thirty-six adults admitted to the neurocritical care unit who received at least one dose of conivaptan (5 patients) or tolvaptan (31 patients) between June 2012 and May 2013...
March 12, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28282848/long-term-vaptan-treatment-of-idiopathic-siadh-in-an-octogenarian
#2
Stefan Büttner, Jürgen Bachmann, Helmut Geiger, Nicholas Obermüller
Hyponatremia is the most common and by far underestimated electrolyte disorder in clinical practice. Especially in elderly patients, treatment of symptomatic hyponatremia is challenging. Herein we describe the case of an octogenarian with recurrent symptomatic hyponatremia due to idiopathic syndrome of inappropriate antidiuretic hormone release (SIADH). Fluid restriction was insufficient to prevent repeated episodes of hyponatremia complicated by falls and coma. After introduction of a low-dose therapy with tolvaptan, serum sodium levels as well as the clinical condition were stable under vaptan therapy, without any relapse for more than six years now...
March 8, 2017: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/28214374/a-systematic-review-of-known-interventions-for-the-treatment-of-chronic-non-hypovolaemic-hypotonic-hyponatraemia-and-a-meta-analysis-of-the-vaptans
#3
REVIEW
Sunil Bhandari, Alessandro Peri, Iain Cranston, Rachael McCool, Alison Shaw, Julie Glanville, Larisa Petrakova, Karl O'Reilly
International and national guidelines on the treatment of chronic non-hypovolaemic hypotonic hyponatraemia differ; therefore we have undertaken this systematic review and meta-analysis to investigate the efficacy and safety of interventions for the treatment of chronic non-hypovolaemic hypotonic hyponatraemia. Following registration of the review protocol with PROSPERO, systematic literature searches were conducted to identify randomised and quasi-randomised controlled trials assessing any degree of fluid restriction or any drug treatment with the aim of increasing serum sodium concentration in patients with chronic non-hypovolaemic hypotonic hyponatraemia...
February 18, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/28149029/efficacy-of-conivaptan-and-hypertonic-3-saline-in-treating-hyponatremia-due-to-syndrome-of-inappropriate-antidiuretic-hormone-in-a-tertiary-intensive-care-unit
#4
Sridhar Nagepalli Venkatarami Reddy, Pradeep Rangappa, Ipe Jacob, Rajeswari Janakiraman, Karthik Rao
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...
December 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28002032/hyponatremia-unfavourable-prognostic-factor-in-hepatic-cirrhosis
#5
Aurelia Enescu, F Petrescu, P Mitruţ, V Pădureanu, Octavia Ileana Petrescu, Valeria Carmen Albu, Andreea Larisa Moraru, Anca Ştefania Enescu
Hyponatremia is defined by a level of Na in serum below or equal to 136 mEq/L while in hepatic cirrhosis it is classically considered as relevant only at a level of Na below 130 mEq/L. Hyponatremia frequently occurs in patients with end-stage hepatic disease. The frequency and severity are variable but it has been estimated that it occurs with a frequency of 57% in hospitalized patients with cirrhosis and in those on waiting lists for hepatic transplants. Signs and symptoms of hyponatremia are related to dysfunctions of the central nervous system, due to migration of the water from intravascular space to the brain cells, resulting in the occurrence of cerebral edema...
December 1, 2016: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
https://www.readbyqxmd.com/read/27746291/limited-efficacy-of-tolvaptan-in-patients-with-cirrhosis-and-severe-hyponatremia-real-life-experience
#6
Elisa Pose, Elsa Solà, Salvatore Piano, Elisabetta Gola, Isabel Graupera, Mónica Guevara, Andrés Cárdenas, Paolo Angeli, Pere Ginès
BACKGROUND: Vaptans, vasopressin selective V2-receptor antagonists, represent the first pharmacologic approach to the treatment of hypervolemic hyponatremia in cirrhosis. However, information on the use of vaptans for patients with cirrhosis and hyponatremia in a real-life scenario is limited. Therefore, this study evaluated the effect of tolvaptan on serum sodium in patients with cirrhosis and severe hypervolemic hyponatremia. METHODS: Nine patients with cirrhosis and serum sodium ≤125 mEq/L were included...
March 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/27278221/pharmacologic-approaches-to-electrolyte-abnormalities-in-heart-failure
#7
REVIEW
Justin L Grodin
Electrolyte abnormalities are common in heart failure and can arise from a variety of etiologies. Neurohormonal activation from ventricular dysfunction, renal dysfunction, and heart failure medications can perturb electrolyte homeostasis which impact both heart failure-related morbidity and mortality. These include disturbances in serum sodium, chloride, acid-base, and potassium homeostasis. Pharmacological treatments differ for each electrolyte abnormality and vary from older, established treatments like the vaptans or acetazolamide, to experimental or theoretical treatments like hypertonic saline or urea, or to newer, novel agents like the potassium binders: patiromer and zirconium cyclosilicate...
August 2016: Current Heart Failure Reports
https://www.readbyqxmd.com/read/27253356/treatment-of-severe-hypervolemic-hyponatremia-in-a-child-with-pneumonia
#8
Teresa Genoni, Rossana Tenconi, Giuseppe Bertolozzi, Emanuela Anna Laicini, Giacomo Tardini, Federica Vianello, Ernesto Leva, Gregorio Paolo Milani, Emilio Filippo Fossali
A 21-month-old boy came to our attention because of pneumonia. His weight increased before presentation, and his blood test results showed hyponatremia (116 mEq/L), low plasma osmolarity (241 mOsm/L), and high urine osmolarity (435 mOsm/L). He was treated with 0.9% sodium chloride solution and intravenous furosemide, and sodium levels rose up to 135 mEq/L in 36 hours. No standard treatment is available for severe hyponatremia in children. The use of vaptans in pediatric patients is described in literature, but it lacks evidence about safety and effectiveness...
June 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27037930/the-changing-role-of-sodium-management-in-cirrhosis
#9
REVIEW
Blanca Lizaola, Alan Bonder, Elliot B Tapper, Angela Mendez-Bocanegra, Andres Cardenas
Hyponatremia may occur in patients with cirrhosis and ascites mainly due to water retention and an inability of the kidney to excrete free water. The main reason for this abnormality is related to the fact that these patients have portal hypertension and this leads to systemic vasodilation that in turn activates sodium-retaining and water-retaining systems such as the renin-angiotensin-aldosterone system and arginine vasopressin (AVP). AVP increases solute-free water retention by acting on the V2 receptors of the kidney-collecting tubes...
June 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/26793317/approach-to-hyponatremia-in-congestive-heart-failure-a-survey-of-canadian-specialist-physicians-and-trainees
#10
Amanda Miller, Bonnie Kuehl, Karthik Tennankore, Steven Soroka
BACKGROUND: Hyponatremia is a recognized complication of congestive heart failure (CHF) and is associated with reduced survival. Therefore, early identification and appropriate management of hyponatremia is important. The aim of this study was to determine the general approach amongst Canadian healthcare practitioners and trainees to the identification and management of hyponatremia complicating CHF. METHODS: Respondents completed 15 multiple-choice style questions in 3 case scenarios regarding the approach to management of hyponatremia complicating CHF using an online survey on UKidney...
2016: Canadian Journal of Kidney Health and Disease
https://www.readbyqxmd.com/read/26608493/-is-physiological-saline-really-physiological-hyponatreamia-treatment-small-deviations-from-the-rules-of-appropriate-therapy-create-serious-complications-and-side-effects
#11
REVIEW
Marcin Krotkiewski
Physiological saline can hardly be treated as physiological as it contains qualitatively and quantitatively different amounts of electrolytes. In particular, it contains 50% more chlorine ions than serum. Physiological saline can cause metabolic acidosis and in diabetic patients hyperchloremic acidosis. In comparison with Ringer solution and plasma-lyte, physiological saline is causing higher number of untoward effects and mortality associated with surgery. Ringer solution should be used in the situations requiring expansion of extracellular fluid...
October 2015: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/26556988/do-vasopressin-v2-receptor-antagonists-benefit-cirrhotics-with-refractory-ascites
#12
REVIEW
Hiroshi Fukui
Hyponatremia is a frequent complication of advanced cirrhosis with ascites associated with increased morbidity and mortality. It is caused by an impairment in the renal capacity to eliminate solute-free water and is considered to be related to persistent secretion of vasopressin despite low serum osmolality. This nonosmotic release of vasopressin is mediated by the autonomic nervous system, which senses the underfilling of arterial vascular component. This reduction of effective arterial blood volume is closely related to the development of ascites...
November 7, 2015: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/26553121/hyponatremia-in-the-intensive-care-unit-how-to-avoid-a-zugzwang-situation
#13
Cédric Rafat, Martin Flamant, Stéphane Gaudry, Emmanuelle Vidal-Petiot, Jean-Damien Ricard, Didier Dreyfuss
Hyponatremia is a common electrolyte derangement in the setting of the intensive care unit. Life-threatening neurological complications may arise not only in case of a severe (<120 mmol/L) and acute fall of plasma sodium levels, but may also stem from overly rapid correction of hyponatremia. Additionally, even mild hyponatremia carries a poor short-term and long-term prognosis across a wide range of conditions. Its multifaceted and intricate physiopathology may seem deterring at first glance, yet a careful multi-step diagnostic approach may easily unravel the underlying mechanisms and enable physicians to adopt the adequate measures at the patient's bedside...
December 2015: Annals of Intensive Care
https://www.readbyqxmd.com/read/26311597/hyponatremia-in-cirrhosis-pathogenesis-treatment-and-prognostic-significance
#14
REVIEW
Vikash K Sinha, Benjamin Ko
Cirrhosis is characterized by systemic and splanchnic vasodilation that leads to excessive nonosmotic secretion of vasopressin (antidiuretic hormone). Hyponatremia is a common electrolyte abnormality in advanced liver disease that results from the impaired ability of the kidney to excrete solute-free water that leads to "dilutional" hyponatremia-water retention disproportionate to the retention of sodium. Hyponatremia in liver diseases carries the prognostic burden, correlates with the severity of cirrhosis, and, in recent studies, has also been implicated in the pathogenesis of hepatic encephalopathy...
September 2015: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/26195098/dehydration-hypernatremia-and-hyponatremia
#15
REVIEW
John E Morley
Disturbances of serum sodium are one of the most common findings in older persons. They are also a major cause of hospital admissions and delirium and are associated with frailty, falls, and hip fractures. Both hypernatremia and hyponatremia are potentially preventable. Treatment involves treating the underlying cause and restoring sodium and volume status to normal. The arginine vasopressin antagonists, vaptans, have increased the therapeutic armamentarium available to physicians.
August 2015: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/26095871/-hyponatremias-from-pathophysiology-to-treatments-review-for-clinicians
#16
REVIEW
Antoine Braconnier, Laurence Vrigneaud, Jean-Philippe Bertocchio
Hyponatremia could be defined as a public health topic: too many patients are concerned in both hospitalized and general populations; hyponatremia induces lots of clinical outcomes and a great economic burden. Its pathophysiology involves thirst regulation (hypotonic water intakes) and losses regulation (through the kidney under vasopressin control). Diagnostic approach should insure that hyponatremia reflects hypo-osmolality and hypotonicity: first, a false hyponatremia should be ruled out, then a non-hypotonic one...
July 2015: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/26093130/-hyponatremia-from-guidelines-to-clinical-practice
#17
REVIEW
Giuseppe Regolisti, Laura Bozzoli, Enrico Fiaccadori
The publication, within a short time interval, of a consensus statement on the pathophysiology, diagnosis and treatment of hyponatremia by a panel of experts mainly from the US and of the European Guidelines on the same topic has marked an important step towards reducing the differences in the treatment of this frequent, and potentially fatal, electrolyte disorder. Within this framework, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE), and the European Dialysis and Transplantation Association-European Renal Association, represented by the European Renal Best Practice (ERBP), have developed these Guidelines for clinical practice, that are focused mainly on the diagnosis and the treatment of hyponatremia...
May 2015: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/26054761/the-treatment-of-vasopressin-v2-receptor-antagonists-in-cirrhosis-patients-with-ascites-a-meta-analysis-of-randomized-controlled-trials
#18
Long Yan, Feng Xie, Jiongjiong Lu, Qingqiang Ni, Changying Shi, Caixi Tang, Jiamei Yang
BACKGROUND: Ascites is the most common complication of cirrhosis. It may lead to the consequence of poor prognosis and the deterioration of quality of life. Asopressin V2 receptor antagonists is a kind of vaptans, and it has been proved to be effective in hyponatremia patients. We conducted a meta-analysis about treatment of vaptans in cirrhosis patients with ascites. METHODS: Following our selection criteria, we collected a total of 14 studies containing 16 randomized controlled trials (2620 patients) from a series of database about the treatment with vaptans for cirrhosis with ascites patients...
2015: BMC Gastroenterology
https://www.readbyqxmd.com/read/25924179/employment-of-vasopressin-receptor-antagonists-in-management-of-hyponatraemia-and-volume-overload-in-some-clinical-conditions
#19
REVIEW
C Urso, S Brucculeri, G Caimi
WHAT IS KNOWN AND OBJECTIVE: Hyponatraemia, the most common electrolyte imbalance occurring in hospitalized subjects, is usually classified as hypovolaemic, euvolaemic or hypervolaemic. Hyponatraemia is a predictor of death among subjects with chronic heart failure and cirrhosis. The inappropriate secretion of the antidiuretic hormone (AVP) seems to be of pivotal importance in the decline of serum sodium concentration in these clinical conditions. The objective of this review was to summarize recent progress in management of hyponatraemia in SIADH, cirrhosis and heart failure...
August 2015: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/25908038/hyponatremia-in-cancer-patients
#20
Marco Platania, Elena Verzoni, Milena Vitali
Hyponatremia is the most frequent electrolyte disorder in hospitalized patients but also a well known poor prognostic factor in cancer patients. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is often misdiagnosed by oncologist because of difficulties in the interpretation of laboratory tests. Etiology is heterogeneous but the predominant cause is represented by the unbalance between excessive presence of water and serum sodium deficiency. Ectopic production of arginine vasopressin (AVP) develops more frequently in small cell lung cancer but it is not so rare in other malignancies...
March 2015: Tumori
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