title: Management of severe hyponatremia: infusion of hypertonic saline and desmopressin or infusion of vasopressin inhibitors?
abstract: Rapid correction of severe hyponatremia carries the risk of osmotic demyelination. Two recently introduced methods of correction of hyponatremia have diametrically opposite effects on aquaresis. Inhibitors of vasopressin V2 receptor (vaptans) lead to the production of dilute urine, whereas infusion of desmopressin causes urinary concentration. Identification of the category of hyponatremia that will benefit from one or the other treatment is critical. In general, vaptans are effective in hyponatremias presenting with concentrated urine and, with the exception of hypovolemic hyponatremia, can be used as their primary treatment. Desmopressin is effective in hyponatremias presenting with dilute urine or developing urinary dilution after saline infusion. In this setting, desmopressin infusion helps prevent overcorrection of the hyponatremia. Monitoring of the changes in serum sodium concentration as a guide to treatment changes is imperative regardless of the initial treatment of severe hyponatremia.
authors.affiliation: Renal Section, Medicine Service, Raymond G. Murphy VA Medical Center and Department of Medicine (AHT), University of New Mexico School of Medicine, Albuquerque, New Mexico; Joan C. Edwards School of Medicine (JIS), Marshall University, Huntington, West Virginia; Division of Nephrology and Hypertension, Department of Medicine (DSR), The George Washington University, Washington, District of Columbia; Medicine Service, Raymond G. Murphy VA Medical Center and Department of Medicine (GHM), University of New Mexico School of Medicine, Albuquerque, New Mexico; Department of Surgery (RHG), University of New Mexico School of Medicine, Albuquerque, New Mexico; and Division of Nephrology, Department of Medicine (DM), University of Toledo, Toledo, Ohio.
authors.forename: Antonios H
authors.initials: AH
authors.lastname: Tzamaloukas
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Shapiro
authors.forename: Dominic S
authors.initials: DS
authors.lastname: Raj
authors.forename: Glen H
authors.initials: GH
authors.lastname: Murata
authors.forename: Robert H
authors.initials: RH
authors.lastname: Glew
authors.forename: Deepak
authors.initials: D
authors.lastname: Malhotra
mesh_terms: D000818:Animals; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D019468:Disease Management; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000188:drug therapy*; D007262:Infusions, Intravenous; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012720:Severity of Illness Index; D014667:Vasopressins / Q000037:antagonists & inhibitors* / Q000097:blood
chemical_list: D012462:Saline Solution, Hypertonic; D014667:Vasopressins; D003894:Deamino Arginine Vasopressin