Management of hyponatremia in heart failure: role of tolvaptan.
BACKGROUND
Asymptomatic or clinically mild hyponatremia commonly occurs in the setting of heart failure, especially among elderly and severely decompensated, fluid-overloaded patients, and is associated with increased morbidity and mortality. Successful detection and treatment of hyponatremia by cardiovascular and advanced practice nurses caring for patients with heart failure are part of multidisciplinary team care. Nurses should be able to detect signs and symptoms of hyponatremia and, even when patients are asymptomatic, initiate appropriate treatment promptly to prevent complications.


OBJECTIVE
In this review, the epidemiology and pathophysiology of hyponatremia in heart failure, and signs and symptoms are described. In patients with heart failure, challenges involved in determining the type of hyponatremia (hypervolemic, hypovolemic, or euvolemic) and in correctly managing hyponatremia to prevent serious complications are presented. Conventional treatment options and their limitations are reviewed, and the vasopressin-receptor antagonist tolvaptan, an emerging oral therapy option, is introduced and discussed.


CONCLUSIONS
Hyponatremia is a marker of morbidity and mortality in patients with heart failure. Nurses working collaboratively with other healthcare providers must be able to recognize the condition and understand treatment options, including potential adverse effects of current and emerging therapies. One emerging therapy--tolvaptan--can be used in hypervolemic and euvolemic hyponatremic patients with heart failure to correct serum sodium level without negatively affecting renal function.


CONCLUSIONS
Improved nurse understanding of hyponatremia in patients with heart failure may promote nurse-initiated or nurse-facilitated detection and management, which could decrease mortality and morbidity.
Nursing Research and Innovation, Nursing Institute, Cleveland Clinic, Ohio, USA. albertn@ccf.org
Nancy M
NM
Albert
Sandra
S
Chase
D000208:Acute Disease; D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines / Q000627:therapeutic use*; D002908:Chronic Disease; D006333:Heart Failure / Q000150:complications* / Q000451:nursing; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D045283:Natriuretic Agents / Q000627:therapeutic use*; D000077602:Tolvaptan
D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D045283:Natriuretic Agents; D000077602:Tolvaptan