title: Review and analysis of differing regulatory indications and expert panel guidelines for the treatment of hyponatremia.
abstract: OBJECTIVE
  As evidence grows about the management of hyponatremia, a number of different international and national recommendations/guidelines from professional organizations have recently been published that offer guidance on decision-making. However, they include several important differences that could confuse practising physicians. This article summarizes the key differences in guideline recommendations by various independent groups, taking the marketing authorizations granted by different regulatory agencies into account. It proposes a synthesis of implications for practising physicians as a practical method for resolving these differences as they relate to everyday clinical practice.
  
  
  METHODS
  The authors reviewed all recent guidelines and consensus documents worldwide to assess differences and similarities. They also reviewed licensed indications for therapeutic agents in hyponatremia.
  
  
  RESULTS
  The actual indications for the only pharmacological therapy approved across three continents for the treatment of hyponatremia--the vaptans--differ substantially around the world. The numerous treatment guidelines published to date also fail to achieve agreement on hyponatremia management. The possible reasons for these differences are explored in this paper. The authors emphasize the crucial role that clinical judgment must continue to play in decision-making about the management of hyponatremia in individual patients. Such judgments should take into account appropriate appraisals of evidence by authoritative experts in the field, as well as the decisions of regulatory agencies that have based their approvals on a critical review of the efficacy and safety data for approved treatments for hyponatremia.
  
  
  CONCLUSIONS
  It is clinical judgment rather than guidelines that should dictate the ultimate choices physicians make for their patients, not only in hyponatremia, but in all aspects of medicine.
authors.affiliation: Division of Endocrinology and Metabolism, Georgetown University Medical Center , Washington, DC , USA.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Verbalis
authors.forename: Ashley
authors.initials: A
authors.lastname: Grossman
authors.forename: Charlotte
authors.initials: C
authors.lastname: Höybye
authors.forename: Isabelle
authors.initials: I
authors.lastname: Runkle
mesh_terms: D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use; D003131:Combined Modality Therapy; D032921:Consensus; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007010:Hyponatremia / Q000628:therapy*; D017410:Practice Guidelines as Topic
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists
keywords: Conivaptan; Guidelines; Hyponatremia; Mozavaptan; Sodium; Syndrome of inappropriate anti-diuretic hormone secretion (SIADH); Tolvaptan