title: [The use of tolvaptan in a case of severe hyponatriemia in SIADH during meningitis].
abstract: Vaptans, vasopressin V2 receptor antagonists, are new drugs indicated in the treatment of Inappropriate ADH Secretion Syndrome (SIADH). We report a case of SIADH in a patient affected by AIDS. During a hospitalization for an ongoing CMV meningitis she developed a severe hyponatremia (114 mEq/L), which was initially treated with restriction of free water. When the diagnosis of SIADH was done (plasma Osmolarity 240 mOsm/kg, urinary sodium >30 mEq/24 h, normal volemia, lack of hypocorticosurrenalism and hypothyroidism), tolvaptan was given at the dose of 15 mg/day. Important fluctuations of plasma Na were observed thereafter (119-143 mEq/L). The progressive reduction of the drug (to 2 mg/die) allowed a stable correction of natremia. Unconsciousness determined the impossibility of the patient to freely access to water, thus explaining the fluctuations of natremia and the difficult management of the drug. Only a posology reduction to doses lower than those available for sale allowed a stable correction of natremia.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Rollino
authors.forename: Rosanna
authors.initials: R
authors.lastname: Balbiano
authors.forename: Pietro
authors.initials: P
authors.lastname: Caramello
authors.forename: Dario
authors.initials: D
authors.lastname: Roccatello
mesh_terms: D000328:Adult; D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use*; D001552:Benzazepines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000188:drug therapy* / Q000209:etiology; D007177:Inappropriate ADH Syndrome / Q000150:complications / Q000188:drug therapy*; D008587:Meningitis, Viral / Q000150:complications; D012720:Severity of Illness Index; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D000077602:Tolvaptan