Article
Management of hyponatremia with the vasopressin V2-antagonist Tolvaptan in the neurosurgery
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Authors
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Simeon Georgiev
- Clemenshospital Münster, Klinik für Neurochirurgie, Münster, Deutschland
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Andrea Kleindienst
- Universitätsklinikum Erlangen, Klinik für Neurochirurgie, Erlangen, Deutschland
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Michael Buchfelder
- Universitätsklinikum Erlangen, Klinik für Neurochirurgie, Erlangen, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Hyponatremia below 135 mmol/L is the most frequent electrolyte imbalance and occurs in up to 50 % of neurosurgical patients. The most common cause of hyponatremia in neurosurgical patients is the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The inappropriate oversecretion of antidiuretic hormone (ADH, syn. arginine-vasopressin AVP), causes water retention and volume overload. The aim of the study was to determine the optimal treatment and dosage of the vasopressin V2-antagonist Tolvaptan.
Methods: A cohort study included a total of 315 patients (148 male, 167 female) admitted to the neurosurgical department of the University of Erlangen, Germany over a 5 year period. The control group without hyponatremia consisted of 186 patients (59 %), 39 patients (12 %) were treated with fluid restriction , 41 patients (13,%) were treated with Tolvaptan at 3.75mg and 49 patients (16 %) with Tolvaptan at 7.5mg as an initial dose.
Results: The cumulative average dose for the patients were treated initially with 3.75mg Tolvaptan was 7,63mg and for those who were initially treated with Tolvaptan 7.5mg was 12.83mg. The mean time until normalization oft he serum concentration was 5 days following fluid restriction, 4 days following 3.75mg Tolvaptan and 3,5 days following 7.5mg Tolvatan. No complication due to overcorrection oft the serum sodium concentration occured. However, in both Tolvaptan groups, the cumulative dose was still below the 15mg preparation commercially available, a tight patient surveillance is recommended.
Conclusion: The increased mortality and morbidity as well as the duration of hospitalization, in hyponatremia after intracranial procedures especially pituitary surgery, brain injury and subarachnoid hemorrhage prompts the necessacity for optimizing the treatment. A group of drugs called vaptans can substitute fluid restriction. The selective vasopressin V2 antagonist Tolvaptan in a moderate dose offers a safe and effective treatment in neurosurgical patients suffering from hyponatremia.
