Ouyang et al., "Oral tolvaptan is safe and effective in chronic hyponatremia," Journal of the American Society of Nephrology, vol.
(1) Biochemical severity (a) Mild hyponatremia, 130-135 mmol/L (b) Moderate hyponatremia, 125-129 mmol/L (c) Profound hyponatremia, <125 mmol/L (2) Time of onset (a) Acute hyponatremia <48 hours (b) Chronic hyponatremia >48 hours (3) Symptoms (a) Symptomatic hyponatremia (b) Asymptomatic hyponatremia (4) Volume status (a) Hypovolaemia (b) Normovolaemia (c) Hypervolaemia (5) Serum osmolality (a) Hypotonic hyponatremia, <275 mOsm/kg (b) Isotonic hyponatremia, 275-295 mOsm/kg (c) Hypertonic hyponatremia, >295 mOsm/kg Table 4: Assessment of volume status.
Because ODS commonly is caused by overly rapid correction of hyponatremia, it is necessary to adhere to guidelines for treating chronic hyponatremia
(Table 2, page 48).
increases osteoclast proliferation and activity, while recent hyponatremia reduces reaction time and makes it less likely people will catch themselves if they stumble.
In conclusion, while further data are needed to strengthen its effectiveness and safety, we believe that tolvaptan can be a useful treatment option for euvolemic chronic hyponatremia
due to SIADH in the pediatric age group.
Mallappa et al., "Management challenges in a child with chronic hyponatremia
: use of V2 receptor antagonist," Case Reports in Pediatrics, vol.
Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic hyponatremia
. Circulation 1986;73(2):257-67.
Conversely, when chronic hyponatremia
is treated too fast, the risk is osmotic demyelination (brain cells have adapted and are exposed to sudden changes in tonicity).
exacerbates ammonia-induced brain edema in rats after portacaval anastomosis.
However, it is not clear whether the mechanisms that contribute to the development of chronic hyponatremia
are involved in our study.