A prospective study to compare the clinical efficacy of Tolvaptan with 3% hypertonic saline solution in hospitalized patients having hyponatremia

Vilapurathu, Jobin Kunjumon; Rajarajan, Savitha

doi:10.4103/2279-042x.132710

Cited by 5 publications

(7 citation statements)

References 11 publications

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“…The major differences between the study by Vilapurathu and Rajarajan[ 10 ] and ours were that in their study, the daily dose of tolvaptan used varied between 15 and 30 mg and changes in sodium levels were monitored for 48 h only. We used escalating doses of tolvaptan starting with 15 mg. As daily correction was <6 mEq/L in all patients, dose was increased by 15 mg on a daily basis till 3 rd day.…”

Section: Discussionmentioning

confidence: 80%

“…[ 10 ] It had shown a slightly superior efficacy in raising the serum sodium concentration at both 24-h and 48-h periods in hyponatraemic patients as compared with oral tolvaptan 15–30 mg daily. [ 10 ] At the same time, bolus dose of conivaptan 20 mg alone as well as that followed by an infusion of 40 mg over 24 h for the next 72 h was found to be superior than HTS in this respect. [ 21 24 ]…”

Section: Discussionmentioning

confidence: 99%

“…Based on a previous study by Vilapurathu and Rajarajan,[ 10 ] considering the change in serum sodium in patients receiving 3% HTS versus oral tolvaptan (134.1 ± 0.5 vs. 133.4 ± 0.3) at 48 h, with a confidence interval of 95% and power of 90%, the minimum sample size required to obtain statistically significant results was calculated as 16 (8 in each group). However, we were able to recruit 40 patients during our study period.…”

Section: Methodsmentioning

confidence: 99%

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Efficacy of oral tolvaptan versus 3% hypertonic saline for correction of hyponatraemia in post-operative patients

et al. 2017

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Background and Aims:Hyponatraemia is frequent in post-operative patients and may be corrected with hypertonic saline (HTS). Oral tolvaptan is used to treat hypervolaemic or euvolaemic hyponatraemia. This study was performed to assess the efficacy of oral tolvaptan in correcting postoperative hyponatraemia compared to HTS.Methods:This prospective, randomised study was conducted in 40 symptomatic patients with serum sodium level ≤130 mEq/L. In Group H (n = 20), 3% HTS was infused at 20–30 mL/h aiming for correction of 6 mEq/L/day. Group T received oral tolvaptan 15 mg on the 1st day. If daily correction was <4 mEq/L, the dose was increased by 15 mg/day to a maximum of 45 mg. The primary outcome was serum sodium concentration 48 hours after starting treatment. Paired t-test was used to compare changes in sodium levels.Results:Baseline sodium and values at 12, 24 and 48 h were comparable in both groups. At 72 h, Group T had significantly higher sodium levels as compared to Group H (133.4 ± 1.9 vs. 131.3 ± 2.4 mEq/L). Intragroup analysis had shown a significant increase in sodium levels from baseline values in both groups at 12, 24, 48 and 72 h. Group H had a significantly lower potassium level and lower negative fluid balance on day 3.Conclusion:Oral tolvaptan and 3% HTS were equally effective in correcting hyponatraemia at 48 hours, but serum sodium levels were higher at 72 hours after oral tolvaptan.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Efficacy of oral tolvaptan versus 3% hypertonic saline for correction of hyponatraemia in post-operative patients

et al. 2017

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“…The superiority of 3% hypertonic saline in raising the serum sodium concentration in hyponatraemia patients is well proven. [ 20 ] It is less expensive but carries a risk of volume overload in oliguric or anuric patients. A drawback of hypertonic saline is that it has to be given as an infusion and the duration of drug administration may extend over many hours.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of single dose conivaptan for correction of hyponatraemia in post-operative patients following major head and neck surgeries

et al. 2015

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Background and Aims:Conivaptan, a vasopressin receptor antagonist, is commonly used for the treatment of euvolaemic, hypervolaemic hyponatraemia. Usually, an intravenous (IV) bolus followed by infusion is administered for many days. We decided to assess the effectiveness of single dose conivaptan for correction of hyponatraemia in post-operative patients.Methods:This was a prospective, randomised trial conducted in 40 symptomatic post-operative Intensive Care Unit (ICU) patients with a serum sodium level of ≤130 mEq/L. Group A patients received IV conivaptan 20 mg over 30 min, whereas in group B infusion of 3% hypertonic saline was started as an infusion at the rate of 20–30 ml/h. Serum sodium levels were measured at 12, 24, 48 and 72 h and the daily fluid balance was measured for 3 days. The Chi-square test, Wilcoxon signed rank test and Mann-Whitney tests were used as applicable.Results:The serum sodium levels before initiating treatment were comparable between groups. However, subsequent sodium levels at 12, 24 and 48 h showed significantly high values in group A. Though at 72 h the mean sodium value was high in group A, it was not statistically significant. Group A showed a significantly high fluid loss on day 1, 2 and 3. The mean volume of hypertonic saline required in group B showed a steady decline from day 1 to 3 and only 13 patients required hypertonic saline on the 3rd day.Conclusion:Single dose conivaptan is effective in increasing serum sodium levels in post-operative ICU patients up to 72 h associated with a significant negative fluid balance.

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“… 7 A prospective observational study comparing the use of 3% HS and tolvaptan, indicated that the 3% HS was more efficient in increasing the sodium concentration (8.03 ± 0.65 after 24 h) compared to the tolvaptan (5.11 ± 0.66 after 24 h). 8 Another study investigated the use of desmopressin acetate if the rate of sodium correction is excessive and indicated that desmopressin acetate decreased the sodium at a rate of 0.81 mmol/L per hour. 9 Although there are studies comparing 3% HS with various medications, there are many aspects in the management of hyponatremia that requires additional research, such as comparing HS with normal saline.…”

Section: Introductionmentioning

confidence: 99%

Hyponatremia management among patients admitted to tertiary hospital: A retrospective evaluation

et al. 2022

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Objective: The aim of this study is to compare the adherence to the guidelines in patients presenting with hyponatremia defined as a sodium (Na) level ⩽120 mEq/L, treated with 3% hypertonic saline or normal saline. The comparison included 3% hypertonic saline use, safe serum sodium increases within 24 and 48 h, frequency of hyponatremia-related complications, and length of stay. Methods: This retrospective observational study enrolled 122 patients with serum sodium ⩽120 mEq/L admitted to the Internal Medicine Department, King Abdulaziz Medical City, National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia, from January 2016 to December 2017. The patients were treated with either 3% hypertonic saline or normal saline. Results: Of the 122 patients, 105 (83.3%) received normal saline, and 17 (13.5%) received hypertonic saline. In the normal saline group, the mean serum sodium increase at 24 h was lower (6.60 ± 4.75) compared to the hypertonic saline group (9.24 ± 5.04). The length of stay was longer in the normal saline group (10.35 ± 13.90) compared to the hypertonic saline group (4.35 ± 3.39). A small proportion (8.7%) of the normal saline group had a serum sodium increase >12 mg/dL at 24 h compared to 29.4% for the hypertonic saline group, and the difference was statistically significant (p value = 0.013). Almost one-third of the sample (36%) presented with complications, the majority (77.3%, n = 34) had a serum sodium of ⩽115 mg/dL, and 22.7% (n = 10) with a serum sodium of 116–120 mg/dL (p value = 0.041). Conclusion: Despite the strong recommendation for 3% hypertonic saline use in severe hyponatremia, many practitioners still use normal saline, even in patients with serum sodium ⩽120 mEq/L. Normal saline showed some efficacy in managing hyponatremia in asymptomatic cases; however, severe cases may have a delayed correction, hyponatremia-related complications, and an extended length of stay.

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A prospective study to compare the clinical efficacy of Tolvaptan with 3% hypertonic saline solution in hospitalized patients having hyponatremia

Cited by 5 publications

References 11 publications

Efficacy of oral tolvaptan versus 3% hypertonic saline for correction of hyponatraemia in post-operative patients

Efficacy of oral tolvaptan versus 3% hypertonic saline for correction of hyponatraemia in post-operative patients

Effectiveness of single dose conivaptan for correction of hyponatraemia in post-operative patients following major head and neck surgeries

Hyponatremia management among patients admitted to tertiary hospital: A retrospective evaluation

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