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Vaptans

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https://www.readbyqxmd.com/read/27746291/limited-efficacy-of-tolvaptan-in-patients-with-cirrhosis-and-severe-hyponatremia-real-life-experience
#1
Elisa Pose, Elsa Solà, Salvatore Piano, Elisabetta Gola, Isabel Graupera, Mónica Guevara, Andrés Cárdenas, Paolo Angeli, Pere Ginès
BACKGROUND: Vaptans, vasopressin selective V2-receptor antagonist, represent the first pharmacological 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 very 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 <125mEq/L were included...
October 13, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27278221/pharmacologic-approaches-to-electrolyte-abnormalities-in-heart-failure
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
https://www.readbyqxmd.com/read/25906004/-use-of-vaptans-in-treatment-of-hyponatremia
#16
REVIEW
Aslı Tanındı, Hasan Fehmi Töre
Hyponatremia is the most prevalent electrolyte imbalance, and may be present in up to 30% of hospitalized patients. It is an important predictor of in-hospital mortality. Irrespective of the reason underlying hyponatremia, water metabolism plays an important role. Arginine-vasopressin, which has cardiovascular effects and plays a role in water metabolism, is released from the posterior hypothalamus in response to an increase in plasma osmolality or a drop in the blood pressure, which are detected by osmoreceptors and baroreceptors respectively...
April 2015: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/25822386/diagnosis-and-management-of-sodium-disorders-hyponatremia-and-hypernatremia
#17
Michael M Braun, Craig H Barstow, Natasha J Pyzocha
Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Sodium disorders are associated with an increased risk of morbidity and mortality. Plasma osmolality plays a critical role in the pathophysiology and treatment of sodium disorders. Hyponatremia and hypernatremia are classified based on volume status (hypovolemia, euvolemia, and hypervolemia). Sodium disorders are diagnosed by findings from the history, physical examination, laboratory studies, and evaluation of volume status...
March 1, 2015: American Family Physician
https://www.readbyqxmd.com/read/25702667/efficacy-and-safety-of-long-term-tolvaptan-treatment-in-a-patient-with-sclc-and-siadh
#18
Paola Bordi, Marcello Tiseo, Sebastiano Buti, Giuseppe Regolisti, Andrea Ardizzoni
Hyponatremia frequently occurs in patients with cancer and is mostly due to a syndrome of inappropriate antidiuresis caused by ectopic secretion of antidiuretic hormone (SIADH). Small cell lung cancer presents with SIADH in approximately 11%-15% of cases. Recently, a new class of drugs, vasopressin V2-receptor antagonists (vaptans), emerged as a promising treatment for SIADH, but efficacy and safety data in cancer patients are lacking. We present a case of SIADH, heralding small cell lung cancer and persisting after apparent complete remission of primary tumor following chemotherapy/radiotherapy, in a patient who underwent long-term treatment with tolvaptan without any serious adverse effects...
March 2015: Tumori
https://www.readbyqxmd.com/read/25514088/aquaporins-vasopressin-and-aging-current-perspectives
#19
REVIEW
Grazia Tamma, Nandu Goswami, Johannes Reichmuth, Natale G De Santo, Giovanna Valenti
Functioning of the hypothalamic-neurohypophyseal-vasopressin axis is altered in aging, and the pathway may represent a plausible target to slow the process of aging. Arginine vasopressin, a nine-amino acid peptide that is secreted from the posterior pituitary in response to high plasma osmolality and hypotension, is central in this pathway. Vasopressin has important roles in circulatory and water homoeostasis mediated by vasopressin receptor subtypes V1a (vascular), V1b (pituitary), and V2 (vascular, renal)...
March 2015: Endocrinology
https://www.readbyqxmd.com/read/25493947/vasopressin-receptor-antagonists-heart-failure-and-polycystic-kidney-disease
#20
REVIEW
Vicente E Torres
The synthesis of nonpeptide orally bioavailable vasopressin antagonists devoid of agonistic activity (vaptans) has made possible the selective blockade of vasopressin receptor subtypes for therapeutic purposes. Vaptans acting on the vasopressin V2 receptors (aquaretics) have attracted attention as a possible therapy for heart failure and polycystic kidney disease. Despite a solid rationale and encouraging preclinical testing, aquaretics have not improved clinical outcomes in randomized clinical trials for heart failure...
2015: Annual Review of Medicine
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