title: Novel Use of Tolvaptan in a Pediatric Patient With Congestive Heart Failure Due to Duchenne Muscular Dystrophy and Congenital Adrenal Hyperplasia.
abstract: Successful management of hyponatremia in heart failure patients requires a multifaceted approach in order to preserve end-organ function. We describe the novel use of a selective vasopressin receptor antagonist, tolvaptan, for management of hyponatremia in a 17-year-old Caucasian male with severe Duchenne muscular dystrophy, congestive heart failure (CHF), and congenital adrenal hyperplasia. The medical history was significant for recurrent admissions for hyponatremia secondary to adrenal crises, which was also exacerbated by his CHF. After initiation of tolvaptan and its extended administration, he had no further hyponatremia-related admissions and no adverse reactions. The complexity of this combination of conditions is presented, and the efficacy of the drug and the rationale behind the treatment approach is discussed.
authors.affiliation: Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Cardiology, Houston, Texas.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Sami
authors.affiliation: Texas Children's Hospital, Department of Pharmacy, Houston, Texas.
authors.forename: Brady S
authors.initials: BS
authors.lastname: Moffett
authors.affiliation: Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Cardiology, Houston, Texas.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Karlsten
authors.affiliation: Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Cardiology, Houston, Texas.
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Cabrera
authors.affiliation: Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Cardiology, Houston, Texas.
authors.forename: Jack F
authors.initials: JF
authors.lastname: Price
authors.affiliation: Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Cardiology, Houston, Texas.
authors.forename: William J
authors.initials: WJ
authors.lastname: Dreyer
authors.affiliation: Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Cardiology, Houston, Texas.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Denfield
authors.affiliation: Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Cardiology, Houston, Texas.
authors.forename: Aamir
authors.initials: A
authors.lastname: Jeewa
keywords: Duchenne muscular dystrophy; congenital adrenal hyperplasia; hyponatremia; tolvaptan