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

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.

Efficacy of vaptans for correction of postoperative hyponatremia: A comparison between single intravenous bolus conivaptan vs oral tolvaptan

“…A single intravenous bolus of 20 or 40 mg conivaptan was found to be effective for the correction of acute hyponatremia and the effect of intermittent bolus dosing lasts up to 72 h.[ 9 10 ] Bolus dose of conivaptan 20 mg followed by an infusion of 40 mg over 24 h for the next 72 h was found to be superior than hypertonic saline in correcting hyponatremia. [ 11 ] Oral conivaptan 40 or 80 mg/day for 5 days had also shown similar effects. [ 12 ] The side effects include postural hypotension,[ 13 14 ] hypokalemia and osmotic demyelination syndrome on rapid overcorrection.…”

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

“…[ 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 ]…”