Conivaptan is approved by the United States Food and Drug Administration (FDA) for hypervolemic
(nephrotic syndrome, cardiac failure and cirrhosis) or euvolemic hyponatremia (SIADH) treatment in adults, but not in children (10).
Dose comparison of conivaptan (Vaprisol[R]) in patients with euvolemic or hypervolemic
hyponatremia-efficacy, safety, and pharmacokinetics.
 Mittal M et al studied 250 patients with mean age of 53.9 years predominated by males with 61.6% patients had euvolemic 21.2% hypervolemic
and 17.2% hypovolemic hyponatremia.
* Hypovolemic or hypervolemic
(congestive heart failure, cirrhosis, patients on dialysis, etc.) in clinical evaluation and physical exam;
Additional information about the patients' volume status contributes to a better understanding of their general condition, and is even more important if we know that some of them can be hypervolemic
and asymptomatic [1, 7].
Based on history and clinical examination patients were classified as hypovolemic hyponatremia, hypervolemic
hyponatremia and euvolemic hyponatremia.
Both are indicated for euvolemic and hypervolemic
Transesophageal echocardiographic monitoring of preoperative acute hypervolemic
Although fluid loading can be helpful by restoring the renal perfusion pressure in many hypovolemic patients with prerenal failure, it may be deleterious in hypervolemic
patients with renal hypoperfusion related to a low cardiac output, where further fluid loading can lead to pulmonary edema and deterioration in oxygenation .
(cylinder tangent effect)  Cross-sectional view  Overestimate intravascular volume Cardiac tamponade Preload dependent Severe valvular stenosis Preload dependent Massive pulmonary embolism  Preload dependent Right ventricular myocardial Preload dependent, decreased infarction  venous return to LV Severe tricuspid regurgitation No difference between High PEEP  PEEP 0 and 5 cm [H.sub.2]0 Decreased tidal volume Decreased inspiratory effort/ Highly collapsible IVC indicates shallow breathing [22, 40] being not hypervolemic
IVC = inferior vena cava, IVC CI = IVC collapsibility index, IVCmax = IVC maximum diameter, PEEP = positive end-expiratory pressure, LV = left ventricle, and HTN = hypertension, cm H20: centimeters of water.
Thus, there is potential in harnessing copeptin concentrations to identify patients with hypervolemic
hyponatremia that may specifically benefit from AVP receptor modulators.