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Severe tolvaptan-associated hyperglycemia: a case report.

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This case study highlights a rare instance of severe hyperglycemia linked to tolvaptan treatment. Close blood glucose monitoring is crucial for patients on prolonged tolvaptan therapy.

Keywords:
Adverse drug reactionHyperglycemiaHyponatremiaTolvaptan

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Area of Science:

  • Endocrinology
  • Pharmacology
  • Nephrology

Background:

  • Hyperglycemia is a rare but serious side effect associated with tolvaptan.
  • This report details a specific case to illustrate this adverse event.

Purpose of the Study:

  • To document a rare case of tolvaptan-induced chronic severe hyperglycemia.
  • To emphasize the importance of monitoring blood glucose levels in patients receiving tolvaptan.

Main Methods:

  • A case report of a 95-year-old male patient with hyponatremia treated with tolvaptan.
  • Monitoring of serum sodium, fasting blood glucose, and glycated hemoglobin A1c before, during, and after tolvaptan treatment.
  • Assessment of causality using the Naranjo probability scale.

Main Results:

  • Tolvaptan treatment led to a dramatic increase in fasting blood glucose (6.3 to 17.2 mmol/L) and HbA1c (5.8% to 9.4%).
  • Hyperglycemia persisted for 5 months after tolvaptan withdrawal, despite insulin therapy.
  • The Naranjo probability scale indicated a probable association between tolvaptan and hyperglycemia (score of 6).

Conclusions:

  • Tolvaptan can cause rare, chronic, and severe hyperglycemia.
  • Proactive blood glucose monitoring is essential during prolonged tolvaptan therapy.
  • This case adds to the limited literature on tolvaptan-associated hyperglycemia.