Syndrome of inappropriate antidiuretic hormone medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
- Fluid restriction
- Intravenous saline
- Drugs
- Demeclocycline
- Conivaptan - an approved antagonist of both V1A and V2 vasopressin receptors. Its indications are "treatment of euvolemic hyponatremia (e.g. the syndrome of inappropriate secretion of antidiuretic hormone, or in the setting of hypothyroidism, adrenal insufficiency, pulmonary disorders, etc.) in hospitalized patients."[1]
- Tolvaptan - an unapproved oral antagonist of the V2 vasopressin receptor. A randomized controlled trial showed conivaptan that can raise the serum sodium by 5 mmol/L. [2]
Care must be taken when correcting hyponatremia. A rapid rise in the sodium level may cause central pontine myelinolysis.[3]
References
- ↑ "Vaprisol (conivaptan hydrochloride) Liquid [Astellas Pharma US, Inc.]".
- ↑ Schrier RW, Gross P, Gheorghiade M; et al. (2006). "Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia". N. Engl. J. Med. 355 (20): 2099–112. doi:10.1056/NEJMoa065181. PMID 17105757.
- ↑ Ashrafian H, Davey P (2001). "A review of the causes of central pontine myelinosis: yet another apoptotic illness?". Eur. J. Neurol. 8 (2): 103–9. PMID 11430268.