[The use of tolvaptan in a case of severe hyponatriemia in SIADH during meningitis].

Abstract

Vaptans, vasopressin V2 receptor antagonists, are new drugs indicated in the treatment of Inappropriate ADH Secretion Syndrome (SIADH). We report a case of SIADH in a patient affected by AIDS. During a hospitalization for an ongoing CMV meningitis she developed a severe hyponatremia (114 mEq/L), which was initially treated with restriction of free water. When the diagnosis of SIADH was done (plasma Osmolarity 240 mOsm/kg, urinary sodium >30 mEq/24 h, normal volemia, lack of hypocorticosurrenalism and hypothyroidism), tolvaptan was given at the dose of 15 mg/day. Important fluctuations of plasma Na were observed thereafter (119-143 mEq/L). The progressive reduction of the drug (to 2 mg/die) allowed a stable correction of natremia. Unconsciousness determined the impossibility of the patient to freely access to water, thus explaining the fluctuations of natremia and the difficult management of the drug. Only a posology reduction to doses lower than those available for sale allowed a stable correction of natremia.

• Authors: Cristiana Rollino, Rosanna Balbiano, Pietro Caramello, Dario Roccatello
• Journal: Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia (G Ital Nefrol) 2013 Nov-Dec Vol. 30 Issue 6 ISSN: 1724-5990 [Electronic] Italy
• Vernacular Title: Utilizzo di tolvaptan in un caso di iponatriemia grave da SIADH.
• PMID: 24402662 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antidiuretic Hormone Receptor Antagonists
• Benzazepines
• Tolvaptan

Topics

• Adult
• Antidiuretic Hormone Receptor Antagonists (therapeutic use)
• Benzazepines (therapeutic use)
• Female
• Humans
• Hyponatremia (drug therapy, etiology)
• Inappropriate ADH Syndrome (complications, drug therapy)
• Meningitis, Viral (complications)
• Severity of Illness Index
• Tolvaptan