Authors
1 Department of Pharmacy Practice, The Erode College of Pharmacy and Research, Veppampalayam, Erode, India
2 Department of Medicine and Cardiology, N. S. Memorial Institute of Medical Sciences, Palathara, Kollam, India
Abstract
Objective: Hyponatremia is one of the most common electrolyte abnormalities in
hospitalized patients. The treatment of hyponatremia is controversial as rapid correction
of serum sodium can give rise to neurologic disorder and at the same time if not corrected
timely, it can lead to brain damage. The aim of this study was to compare the efficacy of
Tolvaptan with 3% hypertonic saline solution for the management of hyponatremia in
hospitalized patients.
Methods: In this prospective observational study, data of 60 hospitalized patients having
hyponatremia from February 2013 to July 2013 were collected and analyzed. Patients
either received oral Tolvaptan or intravenous infusion of 3% hypertonic saline solution. The
serum sodium concentration before administration of treatment and 24 h and 48 h after
the administration of the drugs were recorded and analyzed. Data were analyzed using
GraphPad Software, by Student’s paired t‑test and one‑way analysis of Variance (ANOVA).
Findings: Tolvaptan and 3% hypertonic saline solution had significant effects in raising serum
sodium level in hyponatremic patients at both 24 h and 48 h (P < 0.0001). This increase
was about 8.030 ± 0.6507 mEq/L and 12.33 ± 0.6489 mEq/L for 3% hypertonic saline and
about 5.111 ± 0.6616 mEq/L and 10.11 ± 0.6230 mEq/L for Tolvaptan, after 24 h and 48 h,
respectively.
Conclusion: Both drugs had significant effects in raising serum sodium level in hyponatremic
patients; however administration of 3% hypertonic saline solution had a slightly superior
efficacy in raising the serum sodium concentration at both 24 h and 48 h periods in
Hyponatremic patients compared with oral Tolvaptan.
Keywords
phosphorous homeostasis. In: Dipiro JT, Talbert RL, Yees CG,
Matzke GR, Wells BG, Posey LM, editors. Pharmacotherapy:
A Pathophysiologic Approach. McGraw Hill, Medical
Publishing Division. 2005. p. 937‑67.
2. Zenenberg RD, Carluccio AL, Merlin MA. Hyponatremia:
Evaluation and management. Hosp Pract (1995) 2010;38:89‑96.
3. Hyponatremia: The Merck Manuals: The Merck Manual
for Healthcare Professionals. Available from: http://www.
merckmanals.com/proessional/print/sec/12/ch156/ch156d.
html. [Last accessed on 2013 Aug 04].
4. Craig S, Schraga ED. Hyponatremia in emergency medicine.
Medscape. Retrieved from: http://www.emedicine.medscape.
com/article/767624‑overview. [Last accessed on 2013 Jul 10].
5. Sterns RH, Nigwekar SU, Hix JK. The treatment of
hyponatremia. Semin Nephrol 2009;29:282‑99.
6. Norenberg MD, Leslie KO, RobertsonAS. Association between
rise in serum sodium and central pontine myelinolysis. Ann
Neurol 1982;11:128‑35.
7. Kleinschmidt‑DeMastersBK, NorenbergMD. Rapid correction
of hyponatremia causes demyelination: Relation to central
pontine myelinolysis. Science 1981;211:1068‑70.
8. Helwig FC, Schutz CB, Kuhn HP. Water intoxication.
Moribund patient cured by administration of hypertonic salt
solution. J Am Med Assoc 1938;110:644‑5.
9. Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW,
Sterns RH. Hyponatremia treatment guidelines 2007: Expert
panel recommendations. Am J Med 2007;120:S1‑21.
10. Hyponatremia, Clinical Key; Elsevier. Retrieved from http://
www.clinicalkey.com/topics/nephrology/hyponatremia.html#
sectionTreatmentManagement. [Last accessed on 2013 Jul 10].
11. Thompson C, Hoorn EJ. Hyponatraemia: An overview of
frequency, clinical presentation and complications. Best Pract
Res Clin Endocrinol Metab 2012;26 Suppl 1:S1‑6.
12. Fenske W, Maier SK, BlechschmidtA, Allolio B, Störk S. Utility
and limitations of the traditional diagnostic approach to
hyponatremia: A diagnostic study. Am J Med 2010;123:652‑7.
13. Berl T, Quittnat‑Pelletier F, Verbalis JG, SchrierRW, Bichet DG,
Ouyang J, et al. Oral tolvaptan is safe and effective in chronic
hyponatremia. J Am Soc Nephrol 2010;21:705‑12.
14. Rose BD, Post TW. Clinical Physiology of Acid‑Base and
Electrolyte Disorders. New York: McGraw‑Hill; 2001. p. 583‑8.
15. Wells BG, Dipiro JT, Schwinghammer TL, Dipiro CV.
Electrolyte homeostasis. Pharmacotherapy Handbook. The
McGraw‑Hill Companies, Inc; 2009. p. 881‑96.
16. Reilly T, Chavez B. Tolvaptan (Samsca) for hyponatremia: Is
it a worth salt? Pharm Ther 2009;34:543‑7.
17. Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG,
Czerwiec FS, et al. Tolvaptan, a selective oral vasopressin
V2‑receptor antagonist, for hyponatremia. N Engl J Med
2006;355:2099‑112.
18. Verbalis JG, Adler S, Schrier RW, Berl T, Zhao Q, Czerwiec FS,
et al. Efficacy and safety of oral tolvaptan therapy in patients
with the syndrome of inappropriate antidiuretic hormone
secretion. Eur J Endocrinol 2011;164:725‑32.
)