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Endocrine Abstracts (2016) 41 EP754 | DOI: 10.1530/endoabs.41.EP754


The use of a specific protocol for initiation of tolvaptan therapy in mild/moderate euvolemic hyponatremia secondary to SIADH: not a single case of overcorrection

Angela Amengual1, Ana Ortola1, Irene Crespo1, Rona Penso1, Teresa Ruiz-Gracia1, Emilia Gomez-Hoyos2, Martin Cuesta-Hernandez3, Alejandro Santiago1, Alfonso Calle1 & Isabelle Runkle1


1Hospital Clinico San Carlos, Madrid, Spain; 2Hospital Clinico Valladolid, Valladolid, Spain; 3Beaumont Hospital, Dublin, Ireland.

Introduction: ESE guidelines state a risk for overcorrection of serum sodium levels (SNa) with vaptans. We present the results of our protocol for initiation of tolvaptan(TV) therapy in SIADH.

Methods: Retrospective (2011–15). 86 patients with SIADH-induced mild/moderate hyponatremia received TV:7.5 mg day 1, ad-libitum liquids, no other Na-raising therapies. Conventional hospitalization (CH):66/86, day hospital (DH):20/86. Glycemia-corrected SNa determined at baseline (B), 6, 24, 48 hours post-initial dose. When the 6-hour SNa ascent (SNaAsc) was ≥5 mmol/L, we administered 3 mcg DDAVPsc, with iv 5% dextrose (2 ml/kg/h 2 hours or 3 ml/kg/h 3 hours), when SNaAsc was 6 or >6 mmol/L respectively. Patients received TV15 mg day 2, after register of 24-hour-SNaAsc, or 7.5 mg when the 6-hour SNaAsc≥ 5. TV dose was doubled on day 3 if SNaAsc<3. Overcorrection: >10 mmol/L 24-hour-SNaAsc (>8 with Osmotic-Demyelination-Syndrome risk), >18 in 48 h (>16 with risk). SIADH etiology: ectopic (24/86), pharmacological (16/86), idiopathic of the elderly (9/86), neurological (12/86), others (24/86). Na mmol/L, Osmolality (Osm) mOsm/kg. T-test, X2, Spearman’s Rho. Results in Mean (SD).

Results: 53/86 (61.6%) female, age 72.15 (13.03). Nadir SNa:120.53 (6.27). Baseline: SNa:128.24 (4.14), Plasma Osm: 266.43 (9.16), Urine(U) Osm:450.1 (153.32), UNa:85.18 (44.28). In mg/dl: Uricemia: 3.07(1.43), creatinine 0.67 (0.23). Furst:0.92 (0.36). 6-hour: SNaAsc: 2.2 (2.84), 6-hour-UOsm:229.63 (162.9). SNaAsc≥ 5 in 13/86, 7/20 at DH, 6/68 with CH. NaAsc was higher in patients with lower BSNa (R−-0.292, P=0.006), lower uricemia (R=−0.382, P=0.005), and DH (p=0.01). Patients with SNaAsc≥ 5 had higher BUOsm: 559.46 (188.95) vs. others: BUOsm:438.56 (136.94) (P=0.032). 24-hour: SNaASC: 3.73 (3.06). Those with 6-hour SNaAsc≥ 5: 24-hour SNaAsc: 3.69 (3.43), vs. others: 24-hour SNaASC: 3.74 (3.0) (P=0.96). Maximum 24-hour SNaAsc: 10mmol/L (2/86). 48-hour: SNaAsc from B:6.2 (3.94). Maximum 48-hour SNaAsc:15 (1/86). 42/86 (48.8%) patients had 48-hour SNa≥135. SNa changes at 6.24 and 48 hours were all significant (P<0.001). Two patients referred intense thirst.

Conclusions: With our tolvaptan protocol, there was not a single case of overcorrection. Tolvaptan is safe and effective in the treatment of SIADH patients with mild/moderate hyponatremia. Fluid intake at our Day Hospital must improve.

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