Efficacy of conivaptan and hypertonic (3%) saline in treating hyponatremia due to syndrome of inappropriate antidiuretic hormone in a tertiary Intensive Care Unit.
BACKGROUND
Hyponatremia is one of the most common electrolyte abnormalities encountered in clinical practice and has a significant impact on morbidity and mortality in hospitalized patients. The optimal management of hyponatremia is still evolving. Over the last decade, vaptans have been increasingly used in clinical practice with promising results.


METHODS
The study included eighty patients with symptomatic hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH) admitted and treated in Intensive Care Unit (ICU) with either conivaptan or hypertonic (3%) saline. They were compared for time taken to achieve normal serum sodium, length of ICU and hospital stay, and adverse effects.


RESULTS
The demographic data and serum sodium levels at admission were comparable between the two groups. After initiating correction, sodium levels at 6, 12, and 24 h were similar between the two groups. However, at 48 h, patients in the conivaptan group (Group C) had higher sodium levels (133.0 ± 3.8 mEq/L) as compared to hypertonic saline group (Group HS) (128.9 ± 2.6 mEq/L), which was statistically significant (P< 0.001). The length of ICU stay was less in the Group C (3.35 ± 0.89 days) when compared with the Group HS (4.61 ± 0.91 days) (P< 0.001). There was no signiﬁcant difference in mortality between the two groups.


CONCLUSIONS
In patients with symptomatic hyponatremia due to SIADH, conivaptan with its aquaresis property can achieve a significantly better sodium correction, resulting in reduced ICU and hospital stay with no significant adverse effects.
Department of Intensive Care, Intensive Care Unit, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India.
Sridhar Nagepalli Venkatarami
SN
Reddy
Department of Intensive Care, Intensive Care Unit, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India.
Pradeep
P
Rangappa
Department of Intensive Care, Intensive Care Unit, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India.
Ipe
I
Jacob
Department of Endocrinology, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India.
Rajeswari
R
Janakiraman
Department of Intensive Care, Intensive Care Unit, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India.
Karthik
K
Rao
Conivaptan; hypertonic saline; hyponatremia; syndrome of inappropriate antidiuretic hormone