Evaluation of cases with hyponatremia and tolvaptan treatment in resistant cases

Hyponatremia is the most common electrolyte disorder, especially in hospitalized patients and it represents that plasma sodium concentration is under of 135 mEq / L. In the hospitalized patients, the most common cause of hyponatremia is the inappropriate replacement of parenteral hypotonic fluids. In this study, we reviewed the reasons of hyponatremia and results of treatment modalities and beyond the various clinical symptoms of those patients during the first application with (sodium≤ 125 mEq/L) in emergency service. Furthermore, we evaluated the efficacy of tolvaptan in the hyponatremic cases, which were resistant to conventional treatment methods, which is from the group of antidiuretic hormone (ADH) receptor antagonists (also called as vaptans) tolvaptan with in recent years. Between January 2013 and June 2014 years, we identified the patients retrospectively who were hospitalized with the primary diagnosis of hyponatremia (sodium≤ 125 mEq / L) (n = 150) from the electronic recording system of our hospital. We recorded and evaluated statistically the drugs of patients, their responses to treatment, the comorbid diseases as well as patients demographic, clinical and laboratory data. The study included 72 men, 78 women, with a total of 150 patients (68.7 ± 12.8 years). The average value of sodium at the hospitalization time was 117 mEq/L (max.125 - min.103 mEq / L). In the first evaluation of patients 57% were found to be normovolaemic, 36% of hypervolemic and 7% were hypovolemic. The most common complaints were recorded on the first admission to the hospital as; 38.7% nausea and vomiting, 32% of neurological disorders, shortness of breath 20.7%. İn hyponatremia etiology; the use of multiple drugs with diuretics 36.6% was the first, and than, dilutional hyponatremia related with heart, liver and chronic renal failure was 26% and acute renal failure was found to be 12.7% . According to the group of medicines; diuretics; thiazides (27.3%) was the first that may lead to etiology. The proportion of patients who received hemodialysis with the ultrafiltration purpose was 9.3%. In the study group of 150 patients, only 11 patients were enrolled in the treatment of tolvaptan (7.3%). And at different doses, the rate of positive response was 72.7% with tolvaptan treatment. In a significant proportion of patients, dilutional hyponatremi related to hypervolemia may be responsible from hyponatremia, and that needs the individualization of treatment. Most patients can be corrected with proper treatment and discontinuation of drugs such as diuretics, and some patients with the UF techniques. However, some patients who are resistant to conventional treatments may need to further treatments, such as; tolvaptan. In the coming years, we hope that the use of aquaretiks may be higher than now, with the increasing number of positive similar data with vaptans.