Tolvaptan and urea in paediatric hyponatraemia
Faidra Veligratli1, Demitra Alexandrou1, Sarit Shah1
1Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
Pediatric Nephrology (Berlin, Germany)
|July 19, 2023
Summary
Fluid restriction is difficult for pediatric SIADH patients. Tolvaptan and urea effectively and safely normalized sodium levels in children when fluid restriction was not feasible, with no unexpected side effects observed.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Clinical Pharmacology
Background:
- Syndrome of inappropriate antidiuretic hormone (SIADH) management in children often relies on fluid restriction, which presents challenges for patients requiring obligatory fluid intake.
- Limited pediatric data exist for pharmaceutical interventions like tolvaptan and urea, necessitating further investigation into their efficacy and safety.
Approach:
- A retrospective review was conducted on pediatric inpatients diagnosed with SIADH.
- Data were extracted from electronic health records of patients prescribed tolvaptan and/or urea.
- Key outcome measures included time to sodium normalization, daily sodium change, and maximum 24-hour sodium increase, alongside reported side effects.
Key Points:
- Tolvaptan normalized sodium in 77% of pediatric SIADH patients within a median of 2.5 days, with a median 24-hour sodium increase of 7 mmol/L.
- Urea normalized sodium in 83% of pediatric SIADH patients, with a median 24-hour sodium increase of 2 mmol/L.
- All patients tolerated tolvaptan and urea without significant or unexpected adverse events, even with rapid sodium correction.
Conclusions:
- Tolvaptan and urea represent safe and effective therapeutic options for pediatric SIADH when fluid restriction is impractical.
- These agents offer a viable alternative for managing SIADH in pediatric populations facing challenges with fluid intake.
- Further research may explore optimal dosing and long-term outcomes of tolvaptan and urea in pediatric SIADH.
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