Department of Neurological Surgery, University of California, San Francisco, California 94143-0112, USA.
Neurosurgery. 2011 Aug;69(2):268-73. doi: 10.1227/NEU.0b013e318218c78f.
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of hyponatremia in hospitalized patients and is frequently associated with neurologic disorders and neurosurgical procedures. Traditional therapies such as fluid restriction, sodium repletion, and diuretics can help correct hyponatremia but do not address the underlying pathophysiology of excess arginine vasopressin secretion. Conivaptan is an arginine vasopressin receptor antagonist that has been shown to be both safe and effective in the treatment of euvolemic and hypervolemic hyponatremia.
To analyze the use of conivaptan to treat SIADH in a mixed neurosurgical population.
We conducted a retrospective review of 13 patients with neurosurgical disorders with SIADH that were treated with intravenous conivaptan at our institution between 2007 and 2009.
The mean pretreatment serum sodium concentration was 125.8 ± 3.5 mEq/L. Conivaptan administration resulted in a rise in serum sodium to 132.5 ± 5.6 mEq/L at 12 hours (P < .01) and 134.1 ± 4.7 mEq/L at 24 hours posttreatment (P < .01). The mean time to an increase in serum sodium ≥ 6 mEq/L was 17.8 hours. There were no instances of rapid overcorrection. There were 3 cases of asymptomatic hyperkalemia, 3 cases of asymptomatic hypotension, and 1 case of elevated creatinine associated with conivaptan administration.
These data provide further support that conivaptan can be safely used for the treatment of SIADH-induced hyponatremia in the neurosurgical arena.
抗利尿激素分泌不当综合征（SIADH）是住院患者低钠血症的最常见原因，常与神经疾病和神经外科手术有关。传统的治疗方法，如限制液体摄入、补充钠和使用利尿剂，可以帮助纠正低钠血症，但不能解决抗利尿激素分泌过多的潜在病理生理学问题。盐酸考尼伐坦是一种抗利尿激素受体拮抗剂，已被证明在治疗等容性和高容量性低钠血症时既安全又有效。
分析盐酸考尼伐坦治疗混合神经外科人群中 SIADH 的效果。
我们对 2007 年至 2009 年期间在我院接受静脉注射盐酸考尼伐坦治疗的 13 例神经外科疾病合并 SIADH 的患者进行了回顾性分析。
患者治疗前血清钠浓度的平均值为 125.8 ± 3.5 mEq/L。盐酸考尼伐坦治疗后 12 小时血清钠浓度升高至 132.5 ± 5.6 mEq/L（P <.01），24 小时后升高至 134.1 ± 4.7 mEq/L（P <.01）。血清钠增加≥6 mEq/L 的平均时间为 17.8 小时。没有出现快速过度纠正的情况。有 3 例无症状性高钾血症、3 例无症状性低血压和 1 例与盐酸考尼伐坦治疗相关的肌酐升高。
这些数据进一步支持盐酸考尼伐坦可安全用于治疗神经外科领域 SIADH 引起的低钠血症。
