Tolvaptan utilization in children with chronic hyponatremia due to inappropriate antidiuretic hormone secretion (SIADH). Three case reports and review of the literature.

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tolvaptan 25 endocrinologydiseasesdrugs
adrenal insufficiency 3 endocrinologydiseases
arginine vasopressin 1 endocrinologydiseasesdrugs
cortisol 1 endocrinologydiseasesdrugs
obesity 2 endocrinologydiseases
phenobarbital 2 endocrinologydiseasesdrugs
Hyponatremia 4 endocrinologydiseases
demeclocycline 2 endocrinologydiseasesdrugs
fludrocortisone 1 endocrinologydiseasesdrugs
hypervolemia 1 endocrinologydiseases
hypothyroidism 3 endocrinologydiseases

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Select Drug Character Offset Drug Term Instance
arginine vasopressin 1239 toxicity and poor tolerance. Recently, a new therapeutic option has been developed, a class of non-peptide arginine vasopressin receptor antagonists called vaptans. Tolvaptan is the only such agent approved in Europe for the treatment
cortisol 13657 chronic hyponatremia due to SIADH. Other causes of euvolemic hyponatremia such as hypothyroidism or hypo cortisol ism were excluded in case 2. The patients described in cases 1 and 3 were already taking substitutive
demeclocycline 1044 intravenous isotonic or hypertonic solutions are administered in hypovolemic conditions. The utilization of demeclocycline and urea is not indicated in pediatric ages due to lack of data on their toxicity and poor tolerance.
demeclocycline 4135 treatment of the underlying disease. Loop diuretics are also available for treatment in children, while demeclocycline and urea are not allowed due to lack of adequate data on their toxicity and tolerance.Euvolemic hyponatremia
fludrocortisone 12073 Corticosteroid dosage increase (oral cortone acetate 40-50 mg/m2/day), mineralocorticoid treatment (oral fludrocortisone , 0.1 mg/day), and salt supplement (oral NaCl 3 g/day) were not sufficient to maintain serum sodium at
phenobarbital 7535 occurred; serum sodium level was decreased at 125 mmol/L. The acute episode was treated with intravenous phenobarbital and isotonic saline solution. Brain magnetic resonance imaging (MRI) and computed tomography (CT) scan
phenobarbital 10409 urine sodium 144 mmol/L, urine osmolality 502 mOsm/kg).The acute episode was treated with intravenous phenobarbital and hypertonic saline solution and with orally administered levetiracetam at discharge. As chronic hyponatremia
tolvaptan 1477 hyponatremia caused by syndrome of inappropriate antidiuretic hormone secretion (SIADH) in adults. In USA, tolvaptan and conivaptan have been approved for treatment of euvolemic and hypervolemic hyponatremia. Few data
tolvaptan 1837 trial is still ongoing. Here, we report three children with chronic hyponatremia due to SIADH in which tolvaptan has been used successfully.What is already known on this topic?Actually, the European Medicines Agency
tolvaptan 1968 successfully.What is already known on this topic?Actually, the European Medicines Agency has only approved tolvaptan , a selective V2-receptor antagonist, for the treatment of hyponatremia due to syndrome of inappropriate
tolvaptan 2196 hormone secretion (SIADH) in adults, whereas the United State Food and Drug Administration recommend tolvaptan and conivaptan for the treatment of both euvolemic and hypervolemic hyponatremia in adults. Many researchers
tolvaptan 2348 euvolemic and hypervolemic hyponatremia in adults. Many researchers have reported their results with tolvaptan treatment in hypervolemic hyponatremia due to heart failure or polycystic kidney disease. Tolvaptan
tolvaptan 2708 licensed yet neither in Europe nor in the USA.What this study adds?In this paper, we report the use of tolvaptan in 3 children affected by chronic euvolemic hyponatremia due to SIADH. Tolvaptan has been used respectively
tolvaptan 5846 repletion of electrolytes unnecessary ([6]).Actually, the European Medicines Agency (EMA) has only approved tolvaptan , a selective V2-receptor antagonist, for the treatment of hyponatremia due to SIADH, whereas the US
tolvaptan 6009 treatment of hyponatremia due to SIADH, whereas the US Food and Drug Administration (FDA) has approved both tolvaptan and conivaptan as non-selective V1/V2 receptor antagonists for the treatment of both euvolemic and hypervolemic
tolvaptan 6683 schedules.We report three pediatric cases of chronic severe hyponatremia due to SIADH who received tolvaptan treatment once the hyponatremia became symptomatic.CASE REPORTSCase 1This male patient was a case of
tolvaptan 8469 ranging from 127 to 133 mmol/L. For this reason, we decided to start an oral low-dose treatment with tolvaptan at 3.75 mg (0.06 mg/kg/day), which was increased to 7.5 mg and then to 11.25 mg after few days (Figure
tolvaptan 8614 was increased to 7.5 mg and then to 11.25 mg after few days (Figure 1).At present, after 4 years of tolvaptan treatment (present dose 11.25 mg/day, i.e. 0.2 mg/kg/day), the serum sodium levels are stable (ranging
tolvaptan 10565 orally administered levetiracetam at discharge. As chronic hyponatremia became symptomatic over time, tolvaptan was started in a dose of 3.75 mg/day (0.1 mg/kg/day, weight 35 kg), then increased to 7.5 mg (Figure
tolvaptan 10889 3 years of treatment, serum sodium levels are nearly normal ranging from 133 to 137 mmol/L and the tolvaptan dosage is 11.25 mg/day (0.32 mg/kg/day). No severe hyponatremia has been registered despite the increase
tolvaptan 12235 g/day) were not sufficient to maintain serum sodium at acceptable levels, thus we started low-dose tolvaptan treatment (3.75 mg/day, 0.05 mg/kg/day, weight 83 kg) with prompt normalization of serum sodium (136-141
tolvaptan 12399 with prompt normalization of serum sodium (136-141 mmol/L) as shown in Figure 3.After 3 months, the tolvaptan dosage has been increased to 7.5 mg (0.09 mg/kg/day), the corticosteroid dosage was reduced to a substitutive
tolvaptan 13479 patients affected by SIADH have also a lower osmotic threshold for thirst.Here, we report the results of tolvaptan treatment in three pediatric patients who developed symptomatic chronic hyponatremia due to SIADH. Other
tolvaptan 13888 conditions when they developed severe neurologic symptoms due to hyponatremia. The decision for using tolvaptan was taken due to the severity of symptoms related to the hyponatremic condition and presence of a chronic
tolvaptan 14351 hospital conditions, since frequent monitoring of serum sodium levels is needed in the first hours after tolvaptan administration. In the first days of treatment, serum sodium levels, urinary output, and 24-h fluid
tolvaptan 15043 output. Serum sodium levels get prompt normalization or remain in low-normality range 24-48 hours after tolvaptan administration. In the first days of treatment, an increase in urinary output was observed as expected,
tolvaptan 15932 patients with massive edema due to nephrotic syndrome have been reported ([14],[15]). There are reports of tolvaptan and conivaptan use in pediatric patients with acute hyponatremia who are resistant to isotonic or hypertonic
tolvaptan 16231 and considered to be a safe treatment in all the reported cases. Actually, EMA and FDA have approved tolvaptan only for the treatment of hyponatremia due to SIADH in adults ([19],[20],[21]). Conversely, conivaptan
tolvaptan 16568 conclusion, while further data are needed to strengthen its effectiveness and safety, we believe that tolvaptan can be a useful treatment option for euvolemic chronic hyponatremia due to SIADH in the pediatric age
tolvaptan 17354 patients with severe hyponatremia symptoms.Figure 1Serum sodium and daily urinary output at initiation of tolvaptan treatment and trend in the first two months of treatmentFigure 2Trend of serum sodium and daily urinary
tolvaptan 17505 months of treatmentFigure 2Trend of serum sodium and daily urinary output in the first two months after tolvaptan treatment initiationFigure 3Trend of serum sodium and daily urinary output in the first months after
tolvaptan 17616 treatment initiationFigure 3Trend of serum sodium and daily urinary output in the first months after tolvaptan treatment initiation and withdrawal timing of associated hyponatremia treatment
Select Disease Character Offset Disease Term Instance
Hyponatremia 107 Journal of Clinical Research in Pediatric EndocrinologyTolvaptan Treatment in Children with Chronic Hyponatremia due to Inappropriate Antidiuretic Hormone Secretion: A Report of Three CasesGerdi TuliDaniele TessarisSilvia
Hyponatremia 498 Pediatric Endocrinology, Turin, Italy Publication date (ppub): 9/2017Publication date (epub): 9/2017Abstract Hyponatremia is the most common electrolyte disorder among hospitalized patients and it is sometimes considered as
Hyponatremia 3016 this is the longest period of drug utilization in children with euvolemic hyponatremia.INTRODUCTION Hyponatremia is defined as a serum sodium level below 135 mmol/L and represents the most frequent electrolyte disorder
Hyponatremia 3174 mmol/L and represents the most frequent electrolyte disorder among hospitalized patients ([1],[2]). Hyponatremia can be classified on the basis of volemic state, i.e. hypovolemic, euvolemic, and hypervolemic, or on
adrenal insufficiency 7087 age 5 years had revealed central hypothyroidism requiring treatment with L-thyroxine and then central adrenal insufficiency at age 6 years, at which time, treatment with cortone acetate was started. Over the years of endocrinological
adrenal insufficiency 11047 severe hyponatremia has been registered despite the increase in the size of the tumour mass and central adrenal insufficiency onset.Case 3This 5-year-old boy developed chronic euvolemic hyponatremia due to SIADH after neurosurgical
adrenal insufficiency 11559 levels ranging from 123 mmol/L to 130 mmol/L. As he developed central hypothyroidism and secondary adrenal insufficiency , a substitutive treatment for these conditions was started. He also developed central precocious puberty
hypervolemia 789 asymptomatic patients. The conventional treatment consists of fluid restriction in presence of euvolemia or hypervolemia ; loop diuretics are used in some hypervolemic conditions such as cardiac heart failure, liver cirrhosis
hypothyroidism 7018 for endocrinological follow-up. The initial hormonal evaluations at age 5 years had revealed central hypothyroidism requiring treatment with L-thyroxine and then central adrenal insufficiency at age 6 years, at which
hypothyroidism 11530 hyponatremia with serum sodium levels ranging from 123 mmol/L to 130 mmol/L. As he developed central hypothyroidism and secondary adrenal insufficiency, a substitutive treatment for these conditions was started. He also
hypothyroidism 13635 developed symptomatic chronic hyponatremia due to SIADH. Other causes of euvolemic hyponatremia such as hypothyroidism or hypocortisolism were excluded in case 2. The patients described in cases 1 and 3 were already taking
obesity 6823 hyponatremia became symptomatic.CASE REPORTSCase 1This male patient was a case of ROHHAD syndrome (rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation) referred for endocrinological
obesity 9509 central precocious puberty, for which a treatment with LHRH-analogue was begun, and severe hypothalamic obesity .At age 8 years, she had a grand mal seizure episode. Serum sodium level at admission to the Emergency

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