Tolvaptan Treatment in Children with Chronic Hyponatremia due to Inappropriate Antidiuretic Hormone Secretion: A Report of Three Cases

• Published in: Journal of clinical research in pediatric endocrinology Vol. 9; no. 3; pp. 288 - 292
• Main Authors: Tuli, Gerdi, Tessaris, Daniele, Einaudi, Silvia, de Sanctis, Luisa, Matarazzo, Patrizia
• Format: Journal Article
• Language: English
• Published: Istanbul Galenos Yayinevi Tic. Ltd 01.09.2017; Türk Pediatrik Endokrinoloji ve Diyabet Derneği; Galenos Publishing House; Galenos Publishing
• Subjects: Age; Case Report; Children; Dosage and administration; Drug dosages; Drug therapy; Electroencephalography; Electrolytes; FDA approval; Health aspects; Heart failure; Hyponatremia; Kidney diseases; Laboratories; Liver cirrhosis; Lymphoma; Medical imaging; NMR; Nuclear magnetic resonance; Patient outcomes; Patients; Pediatrics; Plasma; Sodium; Tıp; Tolvaptan; Urine; İstanbul; Türkiye; syndrome of inappropriate antidiuretic hormone secretion; Tolvaptan; children; hyponatremia
• ISSN: 1308-5727; 1308-5735
• DOI: 10.4274/jcrpe.4531

Hyponatremia is the most common electrolyte disorder among hospitalized patients and it is sometimes considered as a poor outcome predictor. Its correction is thus indicated, even in asymptomatic patients. The conventional treatment consists of fluid restriction in presence of euvolemia or hypervolemia; loop diuretics are used in some hypervolemic conditions such as cardiac heart failure, liver cirrhosis and nephrotic syndrome, while intravenous isotonic or hypertonic solutions are administered in hypovolemic conditions. The utilization of demeclocycline and urea is not indicated in pediatric ages due to lack of data on their toxicity and poor tolerance. Recently, a new therapeutic option has been developed, a class of non-peptide arginine vasopressin receptor antagonists called vaptans. Tolvaptan is the only such agent approved in Europe for the treatment of hyponatremia caused by syndrome of inappropriate antidiuretic hormone secretion (SIADH) in adults. In USA, tolvaptan and conivaptan have been approved for treatment of euvolemic and hypervolemic hyponatremia. Few data are so far available in paediatric patients, since only one trial has been registered in Europe which includes children and adolescents, but this trial is still ongoing. Here, we report three children with chronic hyponatremia due to SIADH in which tolvaptan has been used successfully.