Evaluation and management of hyponatremia: an emerging role for vasopressin receptor antagonists.
Vasopressin-2 receptor antagonists, collectively known as the 'vaptans', provide a new approach to the treatment of hyponatremia; therefore, an updated Review of the pathophysiology of hyponatremia is particularly timely. After briefly defining hyponatremia and introducing its clinical aspects and complications, we present an approach to the diagnosis and evaluation of hyponatremia that is based primarily on the often-underused concept of free water clearance and, more specifically, the electrolyte-free water clearance. Then we review the use of vasopressin receptor antagonists in the management of hyponatremia from the standpoint of their pharmacology, their mechanism of action, and available efficacy data from clinical trials.
Chen
Sheldon
S
Division of Nephrology/Hypertension, Northwestern University, The Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, IL 60611, USA.
Jalandhara
Nishant
N
Batlle
Daniel
D
D000208:Acute Disease; D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D017483:Receptors, Vasopressin / Q000627:therapeutic use; D018570:Risk Assessment; D012720:Severity of Illness Index; D000077602:Tolvaptan; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000188:drug therapy*
D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D017483:Receptors, Vasopressin; D000077602:Tolvaptan