Intravenous Conivaptan in Neurosurgical Patients with Hyponatremia

Conivaptan can be safely used for the treatment of SIADH-induced hyponatremia in the neurosurgical arena.

New data provide further support that the arginine vasopressin receptor antagonist conivaptan can be safely used for the treatment of syndrome of inappropriate antidiuretic hormone secretion (SIADH)-induced hyponatremia in the neurosurgical arena.

SIADH is the most common cause of hyponatremia in hospitalized patients, note the researchers, who practice in the Department of Neurological Surgery at the University of California, San Francisco. It is frequently associated with neurologic disorders and neurosurgical procedures, according to the abstract of the study, which was published recently in Neurosurgery.

“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,” the researchers wrote. They note that conivaptan has been shown to be both safe and effective in the treatment of euvolemic and hypervolemic hyponatremia.

The goal of their study was to analyze the use of conivaptan to treat SIADH in a mixed neurosurgical population. They conducted a retrospective review of 13 patients with neurosurgical disorders with SIADH that were treated with intravenous conivaptan at their 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,” the researchers note. All told, there were three cases of asymptomatic hyperkalemia, three cases of asymptomatic hypotension, and one case of elevated creatinine associated with conivaptan administration.

SourceUse of Intravenous Conivaptan in Neurosurgical Patients with Hyponatremia From Syndrome of Inappropriate Antidiuretic Hormone Secretion [Neurosurgery]