Maggiore della Carità University Hospital, Novara, Italy.
Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
Intern Emerg Med. 2017 Oct;12(7):993-1001. doi: 10.1007/s11739-016-1508-5. Epub 2016 Jul 21.
Hyponatremia (plasma sodium concentration or [Na] <136 mEq/L) is the most common electrolyte unbalance in clinical practice. Although it constitutes a negative prognostic factor, it frequently remains underdiagnosed and undertreated. Tolvaptan is an oral V-receptor antagonist which produces aquaresis. Given its emerging role in the treatment of dilutional hyponatremia, we aimed to compare the efficacy and safety of two different doses of this drug in an Emergency Department (ED) setting. Consecutive patients with moderate-severe euvolemic or hypervolemic hyponatremia were sequentially assigned to the 15 mg Group and to the 7.5 mg Group, and were revaluated at 6, 12 and 24 h. Further evaluations and administrations were scheduled daily until [Na] correction was achieved or the maximum period of 72 h was exceeded. A 1-month follow-up was performed. Twenty-three patients were enrolled: 12 were included in the 15 mg Group, 11 in the 7.5 mg Group. Both doses significantly elevated the [Na] over 24 h, although the 15 mg Group showed faster corrections than the 7.5 mg Group (12 vs 6 mEq/L/24 h; P = 0.025). An optimal correction rate (within 4-8 mEq/L/24 h) was observed in 45.4 % of the 7.5 mg Group against 25.0 % (P n.s.). The standard dose led to dangerous overcorrections (>12 mEq/L/24 h) in 41.7 % of the patients, while the low dose did not cause any (P = 0.037). No osmotic demyelination syndrome was observed. A 7.5 mg tolvaptan dose can be considered both effective and safe in treating hyponatremia in the ED, while a 15 mg dose implicates too high risk of overcorrection.
低钠血症（血浆钠浓度或[Na]＜136mEq/L）是临床实践中最常见的电解质失衡。尽管它构成了一个负面的预后因素，但它经常被漏诊和治疗不足。托伐普坦是一种口服 V 受体拮抗剂，可产生水排泄。鉴于其在治疗稀释性低钠血症中的新作用，我们旨在比较两种不同剂量的这种药物在急诊室（ED）环境中的疗效和安全性。连续患有中度至重度等容性或高容性低钠血症的患者被顺序分配到 15mg 组和 7.5mg 组，并在 6、12 和 24 小时进行重新评估。进一步的评估和治疗计划每天进行，直到[Na]纠正或达到 72 小时的最大期限。进行了 1 个月的随访。共纳入 23 例患者：15mg 组 12 例，7.5mg 组 11 例。两种剂量在 24 小时内均显著升高[Na]，尽管 15mg 组的校正速度快于 7.5mg 组（12 与 6mEq/L/24h；P=0.025）。7.5mg 组中 45.4%的患者观察到最佳校正率（4-8mEq/L/24h 内），而 25.0%（P n.s.）的患者观察到最佳校正率。标准剂量导致 41.7%的患者出现危险的过度校正（＞12mEq/L/24h），而低剂量未导致任何过度校正（P=0.037）。未观察到渗透性脱髓鞘综合征。7.5mg 托伐普坦剂量可被认为在 ED 治疗低钠血症时既有效又安全，而 15mg 剂量则存在过度校正的风险过高。
