Oral Urea Treatment for Polydipsia-Hyponatremia Syndrome in Patients With Schizophrenia

Kawai, Nobuyoshi; Ishikawa, Kazuhiro; Nemoto, Kiyotaka; Katano, Tsunahiro; Takahashi, Sho; Hori, Takafumi; Asada, Takashi

doi:10.1097/jcp.0b013e3181b3b38c

Cited by 10 publications

(4 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We found several case series demonstrating an increase in serum sodium concentration after 2-7 days for urea (202,203,204,205,206), demeclocycline (207), loop diuretics in combination with oral NaCl (123,125,208), phenytoin (209) and fluid restriction (210). We also identified case series of patients experiencing an increase in serum sodium over a longer time period of up to 12 months for urea (211,212,213), up to 3 weeks for demeclocycline (214,215,216,217,218,219), up to 20 weeks for lithium (220), up to 150 days for furosemide with oral NaCl (221) and up to 30 days in phenytoin (220).…”

Section: Rationale † Why This Question?mentioning

confidence: 92%

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Spasovski

Vanholder

Allolio

et al. 2014

European Journal of Endocrinology

627

671

View full text Add to dashboard Cite

Hyponatraemia, defined as a serum sodium concentration !135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution-and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association -European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

show abstract

Section: Rationale † Why This Question?mentioning

confidence: 92%

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Spasovski

Vanholder

Allolio

et al. 2014

European Journal of Endocrinology

627

671

View full text Add to dashboard Cite

show abstract

“…Use of conivaptan has been allowed for four-days treatment and by the intravenously route. Another anti V2 medication need to be used for patients with persistent SIADH (which is frequent) while urea has no long-term toxicity [25,32,33] and can also be used intravenously, although in the present study the 85 patients with hyponatremia were all treated orally (less expensive than the intravenous route; for example Ureaphil where each bottle of 135 mL contains 40 g urea which need to be dissolved in 5% dextrose) [19,22]. In the large SALT trials with Tolvaptan, patients had free access to water but first day of treatment SNa increases of about 2 to 3 mmol/L and about 7 mmol/L at the end of the study on Day 30 [17].…”

Section: Discussionmentioning

confidence: 99%

Treatment of euvolemic hyponatremia in the intensive care unit by urea

et al. 2010

View full text Add to dashboard Cite

IntroductionHyponatremia in the intensive care unit (ICU) is most commonly related to inappropriate secretion of antidiuretic hormone (SIADH). Fluid restriction is difficult to apply in these patients. We wanted to report the treatment of hyponatremia with urea in these patients.MethodsTwo groups of patients are reported. The first one is represented by a retrospective study of 50 consecutive patients with mild hyponatremia treated with urea. The second group is presented by a series of 35 consecutive patients with severe hyponatremia acquired outside the hospital (≤ 115 mEq/L) who where treated by isotonic saline and urea (0.5 to 1 g/kg/day), administered usually by gastric tube.ResultsIn the first group with mild hyponatremia (128 ± 4 mEq/L) the serum sodium (SNa) increased to a mean value of 135 ± 4 mEq/L (P < 0.001) after two days of urea therapy (46 ± 25 g/day), despite a large fluid intake (> 2 L/day). The mean duration of urea therapy was six days (from 2 to 42 days). Six patients developed hyponatremia again once the urea was stopped, which necessitated its reintroduction. Six patients developed hypernatremia (maximum value 155 mEq/L). In the second group, SNa increased from 111 ± 3 mEq/L to 122 ± 4 mEq/L in one day (P < 0.001). All the patients with neurological symptoms made a rapid recovery. No side effects were observed.ConclusionsThese data show that urea is a simple and inexpensive therapy to treat euvolemic hyponatremia in the ICU.

show abstract

“…Since then, urea has been given in a large population of euvolemic hyponatremia in adults (12,13) or children (27,28) and in short-term (13) or long-term (years) (12,(29)(30)(31) use. Oral urea has also been used for other indications, such as Ménière disease (32), glaucoma, and brain edema (33).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Tolerance of Urea Compared with Vaptans for Long-Term Treatment of Patients with SIADH

Soupart

Coffernils²,

Couturier

et al. 2012

Clinical Journal of the American Society of Nephrology

130

View full text Add to dashboard Cite

SummaryBackground and objectives Vaptans (vasopressin V 2 -receptor antagonists) are a new approach for the treatment of hyponatremia. However, their indications remain to be determined, and their benefit compared with that of the usual treatments for the syndrome of inappropriate antidiuretic hormone secretion (SIADH) have not been evaluated. This prospective, long-term study compared the efficacy, tolerability, and safety of two oral vaptans with those of oral urea in patients with SIADH.Design, setting, participants, & measurements Patients with chronic SIADH of various origins were treated first with vaptans for 1 year. After an 8-day holiday period, they received oral urea for an additional 1-year follow-up. Serum sodium was measured every 2 months, and drug doses were adjusted accordingly.Results Thirteen participants were initially included in the study (serum sodium, 12563 mEq/L); 12 completed the 2-year treatment period. Treatment with vaptans (satavaptan, 5-50 mg/d, n=10; tolvaptan, 30-60 mg/day, n=2) increased natremia (serum sodium, 13563 mEq/L) during the 1-year vaptan period without escape. Hyponatremia recurred in the 12 participants when vaptans were stopped (holiday period). Urea improved the natremia with the same efficacy (serum sodium, 13562 mEq/L) as vaptans during the 1-year urea treatment period. One participant treated with tolvaptan withdrew from the study early because of excessive thirst. Another patient receiving urea developed hypernatremia without complications.Conclusions Urea has efficacy similar to that of vaptans for treatment of chronic SIADH. Tolerance is generally good for both agents.

show abstract

Oral Urea Treatment for Polydipsia-Hyponatremia Syndrome in Patients With Schizophrenia

Cited by 10 publications

References 8 publications

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Treatment of euvolemic hyponatremia in the intensive care unit by urea

Efficacy and Tolerance of Urea Compared with Vaptans for Long-Term Treatment of Patients with SIADH

Contact Info

Product

Resources

About