title: Does Accidental Overcorrection of Symptomatic Hyponatremia in Chronic Heart Failure Require Specific Therapeutic Adjustments for Preventing Central Pontine Myelinolysis?
abstract: This review aims at summarizing essential aspects of epidemiology and pathophysiology of hyponatremia in chronic heart failure (CHF), to set the ground for a practical as well as evidence-based approach to treatment. As a guide through the discussion of the available evidence, a clinical case of hyponatremia associated with CHF is presented. For this case, the severe neurological signs at presentation justified an emergency treatment with hypertonic saline plus furosemide, as indicated. Subsequently, as the neurological emergency began to subside, the reversion of the trend toward hyponatremia overcorrection was realized by continuous infusion of hypotonic solutions, and administration of desmopressin, so as to prevent the very feared risk of an osmotic demyelination syndrome. This very disabling complication of the hyponatremia correction is then briefly outlined. Moreover, the possible advantages related to systematic correction of the hyponatremia that occurs in the course of CHF are mentioned. Additionally, the case of tolvaptan, a vasopressin receptor antagonist, is concisely presented in order to underline the different views that have led to different norms in Europe with respect to the USA or Japan as regards the use of this drug as a therapeutic resource against the hyponatremia.
authors.affiliation: Cardiology Unit, Presidio Sanitario Intermedio "Elena d'Aosta", ASL Napoli 1 Centro, via Cagnazzi 29, 80137 Napoli, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: De Vecchis
authors.affiliation: Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07747 Jena, Germany.
authors.forename: Michel
authors.initials: M
authors.lastname: Noutsias
authors.affiliation: Cardiology Unit, Presidio Sanitario Intermedio "Elena d'Aosta", ASL Napoli 1 Centro, via Cagnazzi 29, 80137 Napoli, Italy; Division of Cardiology, Casa di Cura "Sollievo della Sofferenza", viale Cappuccini 2, 71013 San Giovanni Rotondo, Italy.
authors.forename: Carmelina
authors.initials: C
authors.lastname: Ariano
authors.affiliation: Department of Cardiology, Second University of Napoli, Monaldi Hospital, via Leonardo Bianchi, 1, 80131 Napoli, Italy.
authors.forename: Arturo
authors.initials: A
authors.lastname: Cesaro
authors.affiliation: Cardiology Unit, Presidio Sanitario Intermedio "Elena d'Aosta", ASL Napoli 1 Centro, via Cagnazzi 29, 80137 Napoli, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Cioppa
authors.affiliation: Cardiology Unit, Presidio Sanitario Intermedio "Elena d'Aosta", ASL Napoli 1 Centro, via Cagnazzi 29, 80137 Napoli, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Giasi
authors.affiliation: Division of Cardiology, Istituto Nazionale per lo Studio e la Cura dei Tumori,"Fondazione Giovanni Pascale" IRCCS, via Mariano Semmola, 52, 80131 Napoli, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maurea
keywords: Central pontine myelinolysis; Chronic heart failure; Hyponatremia; Therapy