scholarly journals Tolvaptan use during hyperhydration in paediatric intracranial lymphoma with SIADH

2016 ◽  
Vol 2016 ◽  
Author(s):  
Ruben H Willemsen ◽  
Violeta Delgado-Carballar ◽  
Daniela Elleri ◽  
Ajay Thankamony ◽  
G A Amos Burke ◽  
...  
Keyword(s):  
Fluid Balance ◽  
Fluid Intake ◽  
Hormone Secretion ◽  
B Cell Lymphoma ◽  
Urinary Output ◽  
Fluid Restriction ◽  
List Type ◽  
Close Monitoring ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Severe Hyponatraemia

Summary An 11-year-old boy developed severe syndrome of inappropriate antidiuretic hormone secretion (SIADH) after diagnosis of an intracranial B-cell lymphoma. His sodium levels dropped to 118–120 mmol/L despite 70% fluid restriction. For chemotherapy, he required hyperhydration, which posed a challenge because of severe hyponatraemia. Tolvaptan is an oral, highly selective arginine vasopressin V2-receptor antagonist, which has been licensed in adults for the management of SIADH and has been used in treating paediatric heart failure. Tolvaptan gradually increased sodium levels and allowed liberalisation of fluid intake and hyperhydration. Tolvaptan had profound effects on urinary output in our patient with increases up to 8 mL/kg/h and required close monitoring of fluid balance, frequent sodium measurements and adjustments to intake. After hyperhydration, tolvaptan was stopped, and the lymphoma went into remission with reversal of SIADH. We report one of the first uses of tolvaptan in a child with SIADH, and it was an effective and safe treatment to manage severe SIADH when fluid restriction was not possible or effective. However, meticulous monitoring of fluid balance and sodium levels and adjustments of fluid intake are required to prevent rapid sodium changes. Learning points: Tolvaptan can be used in paediatric patients with SIADH to allow hyperhydration during chemotherapy. Tolvaptan has profound effects on urinary output and meticulous monitoring of fluid balance and sodium 
levels is therefore warranted. Tolvaptan was well tolerated without significant side effects.

Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated with Desvenlafaxine

2016 ◽  
Vol 33 (S1) ◽  
pp. S469-S469 ◽  
Author(s):  
E. García Fernández ◽  
D.M.I. Ramos García
Keyword(s):  
Antidiuretic Hormone ◽  
Serum Sodium ◽  
Antidepressant Treatment ◽  
Hormone Secretion ◽  
Urine Osmolality ◽  
Prescription Medication ◽  
Fluid Restriction ◽  
Close Monitoring ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Competing Interest

IntroductionDesvenlafaxine is a prescription medication approved for the treatment of major depressive disorder in adults. Hyponatremia secondary to inappropriate secretion of antidiuretic hormone (SIADH) is a possible side effect in patients receiving serotonin-norepinephrine reuptake inhibitors (SNRIS)MethodTo report a case of SIADH associated with desvenlafaxine.ResultsWe present a 80-year-old female patient who required hospitalization due to an episode of psychotic depression. During the hospitalization, the patient developed hyponatremia after commencing treatment with desvenlafaxine. The serum sodium at this time was 117 mmol/L, serum osmolality was 249 mosmol/kg, urine osmolality 395 mosmol/kg and urine sodium 160 mmol/L, consistent with a diagnosis of SIADH. Desvenlafaxine was ceased and fluid restriction implemented. The mental status improved, and electrolyte studies 6 days later revealed serum sodium and osmolality values of 135 mEq/L during treatment with duoxetine.ConclusionsSIADH has been reported with a range of antidepressants in elderly patients. This case report suggests that desvenlafaxine might cause clinically significant hyponatremia. Close monitoring is recommended in patients starting therapy with antidepressant treatment to study and prevent possible adverse effects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Pre-eclampsia complicated by severe hyponatraemia

2020 ◽  
Vol 13 (12) ◽  
pp. e237827
Author(s):  
Annalisa Montebello ◽  
John Thake ◽  
Sandro Vella ◽  
Josanne Vassallo
Keyword(s):  
Caesarean Section ◽  
Sodium Level ◽  
Hormone Secretion ◽  
Fetal Distress ◽  
Emergency Caesarean Section ◽  
Fluid Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Severe Hyponatraemia ◽  
Fetal Tachycardia

A 41-year-old woman was diagnosed with pre-eclampsia at 35 weeks gestation. She was treated with antihypertensives but, unfortunately, her condition became complicated by severe hyponatraemia. Her sodium levels rapidly dropped to 125 mmol/L. The cause for the hyponatraemia was the syndrome of inappropriate antidiuretic hormone secretion. She was initially managed with fluid restriction, but an emergency caesarean section was necessary in view of fetal distress. Her sodium levels returned to normal within 48 hours of delivery.Pre-eclampsia is rarely associated with hyponatraemia. A low maternal sodium level further increases the mother’s risk for seizures during this state. Additionally, the fetal sodium rapidly equilibrates to the mother’s and may result in fetal tachycardia, jaundice and polyhdraminios. All these factors may necessitate an emergency fetal delivery.

scholarly journals Tolvaptan Use to Treat SIADH in a Child

2018 ◽  
Vol 23 (6) ◽  
pp. 494-498
Author(s):  
Adem Yasin Koksoy ◽  
Meltem Kurtul ◽  
Aslı Kantar Ozsahin ◽  
Fatma Semsa Cayci ◽  
Meltem Tayfun ◽  
...  
Keyword(s):  
Hypertonic Saline ◽  
Treatment Option ◽  
Pediatric Patients ◽  
Hormone Secretion ◽  
Saline Infusion ◽  
Fluid Restriction ◽  
Effective Treatment Option ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Electrolyte Abnormalities ◽  
Hypertonic Saline Infusion

Hyponatremia is one of the most common electrolyte abnormalities encountered in the clinical setting in hospitalized patients. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the leading cause of hyponatremia in most of these cases. While fluid restriction, hypertonic saline infusion, diuretics, and the treatment of underlying conditions constitute the first line of treatment of SIADH, in refractory cases, and especially for pediatric patients, there seems not to be any other choice for treatment. Tolvaptan, although its use in pediatric patients is still very limited, might be an attractive treatment option for correction of hyponatremia due to SIADH. Here we present a pediatric case of SIADH that was resistant to treatment with fluid restriction and hypertonic saline infusion and was treated successfully with tolvaptan. Tolvaptan could be a good, safe, and effective treatment option in pediatric SIADH cases that are resistant to treatment. However, the dosage should be titrated carefully.

scholarly journals Hyponatremia in Acute Stroke Patients: Pathophysiology, Clinical Significance, and Management Options

2019 ◽  
Vol 82 (1-3) ◽  
pp. 32-40 ◽  
Author(s):  
George Liamis ◽  
Fotios Barkas ◽  
Efstathia Megapanou ◽  
Eliza Christopoulou ◽  
Andromachi Makri ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Sodium Level ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Hypertonic Solution ◽  
Stroke Patients ◽  
Volume Depletion ◽  
Management Options ◽  
Cerebral Salt Wasting ◽  
Inappropriate Antidiuretic Hormone Secretion

Background: Hyponatremia is frequent in acute stroke patients, and it is associated with worse outcomes and increased mortality. Summary: Nonstroke-related causes of hyponatremia include patients’ comorbidities and concomitant medications, such as diabetes mellitus, chronic kidney disease, heart failure, and thiazides. During hospitalization, “inappropriate” administration of hypotonic solutions, poor solute intake, infections, and other drugs, such as mannitol, could also lower sodium levels in patients with acute stroke. On the other hand, secondary adrenal insufficiency due to pituitary ischemia or hemorrhage, syndrome of inappropriate antidiuretic hormone secretion, and cerebral salt wasting are additional stroke-related causes of hyponatremia. Although it is yet unclear whether the appropriate restoration of sodium level improves outcomes in patients with acute stroke, the restoration of the volume depletion remains the cornerstone of treatment in hypovolemic hyponatremia. In case of hyper- and euvolemic hyponatremia, apart from the correction of the underlying cause (e.g., withdrawal of an offending drug), fluid restriction, administration of hypertonic solution, loop diuretics, and vasopressin-receptor antagonists (vaptans) are among the therapeutic options. Key Messages: Hyponatremia is frequent in patients with acute stroke. The plethora of underlying etiologies warrants a careful differential diagnosis which should take into consideration comorbidities, concurrent medication, findings from the clinical examination, and laboratory measurements, which in turn will guide management decisions. However, it is yet unclear whether the appropriate restoration of sodium level improves outcomes in patients with acute stroke.

scholarly journals Efficacy and safety of oral tolvaptan therapy in patients with the syndrome of inappropriate antidiuretic hormone secretion

2011 ◽  
Vol 164 (5) ◽  
pp. 725-732 ◽  
Author(s):  
Joseph G Verbalis ◽  
Suzanne Adler ◽  
Robert W Schrier ◽  
Tomas Berl ◽  
Qiong Zhao ◽  
...  
Keyword(s):  
Antidiuretic Hormone ◽  
Health Survey ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Efficacy And Safety ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Days Of Therapy ◽  
Positive Treatment Effect ◽  
Positive Treatment

ObjectiveTolvaptan, an oral antagonist of the vasopressin V2 receptor, has been found to improve hyponatremia in patients with mixed etiologies. This study analyzed a subgroup of patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) to evaluate the efficacy and safety of tolvaptan in this group.Design and patientsHyponatremic patients in the SALT-1 and SALT-2 studies with a diagnosis of SIADH were identified based on clinical diagnosis by individual study investigators. Subjects were randomized to receive oral placebo (n=52) or tolvaptan 15 mg daily, with further titration to 30 and 60 mg daily, if necessary, based on the response of serum [Na+] (n=58).ResultsIn patients with SIADH, improvement in serum [Na+] was significantly greater (P<0.0001) with tolvaptan than placebo over the first 4 days of therapy as well as the entire 30-day study, with minimal side effects of increased thirst, dry mouth, and urination. Only 5.9% of tolvaptan-treated patients had overly rapid correction of hyponatremia as defined by current guidelines. After discontinuation of tolvaptan, serum [Na+] declined to values similar to placebo. A significant positive treatment effect favoring tolvaptan on the physical component, and a near-significant trend on the mental component, was found using the SF-12 Health Survey. Tolvaptan was associated with a significantly reduced incidence of fluid restriction.ConclusionsResults for the SIADH subgroup were analogous to those of the combined SALT population regarding efficacy and safety but demonstrated a greater improvement in the physical component of the SF-12 Health Survey than in the full mixed etiology SALT patient group.

scholarly journals The Management And Outcome of Hyponatraemia Following Transsphenoidal Surgery: A Retrospective Observational Study

2021 ◽  
Author(s):  
Ziad Hussein ◽  
Ploutarchos Tzoulis ◽  
Hani J Marcus ◽  
Joan Grieve ◽  
Neil Dorward ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Transsphenoidal Surgery ◽  
Hormone Secretion ◽  
Female Gender ◽  
Fluid Restriction ◽  
Retrospective Case ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Younger Age ◽  
Risk Patients ◽  
Case Note Review

Abstract Purpose:Hyponatraemia is a common complication following transsphenoidal surgery. However, there is sparse data on its optimal management and impact on clinical outcomes. The aim of this study was to evaluate the management and outcome of hyponatraemia following transsphenoidal surgery.Methods:A prospectively maintained database was searched over a 4-year period between January 2016 and December 2019, to identify all patients undergoing transsphenoidal surgery. A retrospective case-note review was performed to extract data on hyponatraemia management and outcome. Results: Hyponatraemia occurred in 162 patients (162/670; 24.2%) with a median age of 56 years. Female gender and younger age were associated with hyponatraemia, with mean nadir sodium being 128.6 mmol/L on postoperative day 7. Hyponatraemic patients had longer hospital stay than normonatraemic group with nadir sodium being inversely associated with length of stay (p <0.001). In patients with serum sodium ≤132 mmol/L, syndrome of inappropriate antidiuretic hormone secretion (SIADH) was the commonest cause (80/111; 72%). Among 76 patients treated with fluid restriction as a monotherapy, 25 patients (25/76; 32.9%) did not achieve a rise in sodium after three days of treatment. Readmission with hyponatraemia occurred in 11 cases (11/162; 6.8%) at a median interval of 9 days after operation.Conclusion:Hyponatraemia is a relatively common occurrence following transsphenoidal surgery, is associated with longer hospital stay and risk of readmission, and the effectiveness of fluid restriction is limited. These findings highlight the need for further studies to better identify and treat high-risk patients, including the use of AVP receptor antagonists.

scholarly journals Syndrome of recurrent increased secretion of antidiuretic hormone following multiple doses of vincristine

Blood ◽  
1975 ◽  
Vol 45 (3) ◽  
pp. 315-320 ◽  
Author(s):  
MJ Stuart ◽  
C Cuaso ◽  
M Miller ◽  
FA Oski
Keyword(s):  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Repeated Treatment ◽  
Acute Lymphatic Leukemia ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Lymphatic Leukemia ◽  
Specific Radioimmunoassay ◽  
Repeated Use

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been recognized to occur following treatment with vincristine. None of the reports have provided information regarding its potential for recurrence on further challenge with vincristine (VCR), an agent generally required for repeated use in patients with malignancies. Symptomatic hyponatremia and SIADH that occurred 8 days following administration of VCR in a child with acute lymphatic leukemia was documented with specific radioimmunoassay of urinary ADH levels. The further occurrence of recurrent elevations in ADH excretion 8–10 days following repeated treatment with VCR was also observed. However, SIADH was prevented by prophylactic rigorous fluid restriction. The occurrence of SIADH following VCR therefore does not preclude the further safe usage of this drug.

scholarly journals Chronic hyponatremia based on maxillary sinus mass

2021 ◽  
Vol 2021 ◽  
Author(s):  
Darija Tudor ◽  
Iva Kolombo ◽  
Ana Tot ◽  
Drasko Cikojevic ◽  
Marko Simunovic ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Hormone Secretion ◽  
Olfactory Neuroblastoma ◽  
Neurological Symptoms ◽  
List Type ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Gradual Onset ◽  
Chronic Hyponatremia ◽  
The Moment ◽  
Learning Points

Summary This is a case report of a child with chronic hyponatremia due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) as a paraneoplastic manifestation of olfactory neuroblastoma (OFN). We hereby report a clinical presentation as well as a pragmatic approach to one of the most common electrolytic disorders in the pediatric population and have emphasized the necessity of involving the sinonasal area in the diagnostic procedure while evaluating possible causes of SIADH. This report indicates that the chronicity of the process along with the gradual onset of hyponatremia occurrence is responsible for the lack of neurological symptoms at the moment of disease presentation. Learning points Hyponatremia is not infrequently attributed to SIADH. Paraneoplastic syndromes are uncommon but they should be considered in the differential diagnosis of pediatric SIADH. Chronic insidious hyponatremia may not be associated with clear neurological symptoms despite its severity.

Syndrome of Inappropriate Secretion of Antidiuretic Hormone Secondary to Fluoxetine

1993 ◽  
Vol 27 (6) ◽  
pp. 723-724 ◽  
Author(s):  
Joleen V. Blacksten ◽  
Julie A. Birt
Keyword(s):  
Antidiuretic Hormone ◽  
Case Reports ◽  
Hormone Secretion ◽  
Term Therapy ◽  
Fluid Restriction ◽  
Short Term ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Potassium Supplementation ◽  
Days Of Therapy ◽  
Severe Weakness

OBJECTIVE: To report a case of possible fluoxetine-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH). CASE SUMMARY: A 92-year-old patient was prescribed oral fluoxetine 20 mg daily for depression. After 13 days of therapy, she developed severe weakness and was found to have hyponatremia. Fluoxetine was discontinued. Treatment included fluid restriction and sodium chloride and potassium supplementation. Eight days after admission, the hyponatremia resolved and the patient was discharged without any pharmacologic treatment for depression. DISCUSSION: Case reports on fluoxetine-induced SIADH were reviewed. Fluoxetine-associated SIADH appears to occur most commonly after short-term therapy in elderly patients. Resolution of hyponatremia occurs six days to two weeks after discontinuation of fluoxetine. CONCLUSIONS: Geriatric patients receiving fluoxetine should be monitored regularly to detect abnormal electrolyte values.

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