Abstract
Background
The syndrome of inappropriate antidiuretic hormone (SIADH) is usually treated with fluid restriction. This can be challenging in patients with obligate fluid intake for nutrition or medication. Pharmaceutical treatment with tolvaptan and urea is available but minimal paediatric data are available. We review the efficacy and safety of tolvaptan and urea in paediatric patients with SIADH.
Methods
Retrospective review of paediatric inpatients with clinical diagnosis of SIADH. Patients were identified from pharmacy records based on tolvaptan and urea prescriptions. Relevant information was extracted from patient electronic records. The main outcome measures included the number of days to sodium normalisation, the daily change in plasma sodium concentration, and the maximum increase of plasma sodium concentration in 24 h. Reported side effects were captured.
Results
Thirteen patients received tolvaptan and six urea. Five patients had both agents (tolvaptan converted to urea). Tolvaptan led to plasma sodium normalisation in 10/13 (77%) within 6 days (median 2.5 days, range [1, 6]), with a median change of sodium concentration of 7 mmol/L (− 1, 14) within the first 24 h of treatment. Three patients experienced a change in plasma sodium > 10 mmol/l/day but had no apparent side effects. Urea led to sodium normalisation in 5/6 (83%) patients. The median number of days to normalisation with urea was 2 (1, 10) with a median change of plasma sodium concentration of 2 mmol/L (− 1, 6) within the first 24 h. All patients tolerated tolvaptan and/or urea without unexpected side effects.
Conclusions
Tolvaptan and urea appear to be safe and effective when fluid restriction is challenging in paediatric SIADH.
Graphical abstract
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D.B conceptualised and supervised the project. F.V. and D.B. designed the study, collected, analysed, interpreted data and wrote the paper. D.A. and A.F. collected data, C.L. R.A. M.D, H.G., R.T., S.S. contributed data. All authors contributed to data interpretation, final manuscript preparation and reviewed the final version prior to submission.
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Veligratli, F., Alexandrou, D., Shah, S. et al. Tolvaptan and urea in paediatric hyponatraemia. Pediatr Nephrol 39, 177–183 (2024). https://doi.org/10.1007/s00467-023-06091-w
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DOI: https://doi.org/10.1007/s00467-023-06091-w