Tolvaptan treatment of severe stroke-like symptoms and bilateral subcortical diffusion restriction due to syndrome of inappropriate secretion of ADH after polytrauma

There are limited reports on the use of tolvaptan for syndrome of inappropriate antidiuretic hormone secretion (SIADH) in children. Managing serum sodium levels in SIADH patients during chemotherapy is often difficult because of the need for massive fluid infusions. We report the course of the use of tolvaptan for the treatment of hyponatremia during chemotherapy in a four-year-old girl with a suprasellar germ cell tumor. The patient was a Japanese girl who presented with left ptosis with a mass in the pituitary gland and cavernous sinus. She was diagnosed with an intermediate-grade germ cell tumor and was treated with carboplatin and etoposide combination chemotherapy. She developed hyponatremia due to SIADH caused by intravenous infusion therapy before chemotherapy. Subsequently, tolvaptan (3.25 mg; 0.20 mg/kg/dose) was administered orally to control serum sodium levels. After 4 h of administration, a marked increase in urine volume of up to 15 mL/kg/h was observed, and serum sodium level increased from 126 to 138 mEq/L after 10 h of tolvaptan administration, followed by a decrease in urine volume. The use of tolvaptan in pediatric patients with SIADH who require intravenous hydration during chemotherapy can be useful for the management of serum sodium balance.

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“…Reports of tolvaptan use for SIADH in children are limited [6][7][8][9][10][11]. The reported pediatric patients are summarized in Table 2.…”

Section: Discussionmentioning

confidence: 99%

Regulation of Serum Sodium Levels during Chemotherapy Using Selective Arginine Vasopressin V2-Receptor Antagonist Tolvaptan in a Four-Year-Old Girl with a Suprasellar Germ Cell Tumor

et al. 2021

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“…To date, there are few data regarding the use of vaptans in paediatrics ( 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ). The youngest patient treated was 2 years and 4 months old and the treatment dose ranged from 0.22 to 0.8 mg/kg ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…Its use in the pediatric age group in patients with hypervolemic hyponatremia due to congestive cardiac failure with restrictive cardiomyopathy and in 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 fluids administration ( 16 , 17 , 18 ). Tolvaptan treatment was well-tolerated and considered to be a safe treatment in all the reported cases.…”

Section: Discussionmentioning

confidence: 99%

Tolvaptan Treatment in Children with Chronic Hyponatremia due to Inappropriate Antidiuretic Hormone Secretion: A Report of Three Cases

Tuli¹,

Tessaris²,

Einaudi³

et al. 2017

Jcrpe

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Hyponatremia is the most common electrolyte disorder among hospitalized patients and it is sometimes considered as a poor outcome predictor. Its correction is thus indicated, even in 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 and nephrotic syndrome, while 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. 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 of 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 are so far available in paediatric patients, since only one trial has been registered in Europe which includes children and adolescents, but this trial is still ongoing. Here, we report three children with chronic hyponatremia due to SIADH in which tolvaptan has been used successfully.

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“…However data on the safety, efficacy and optimal dose of tolvaptan in pediatric patients are limited. There are a few case reports concerning tolvaptan therapy for pediatric SIADH (3,5,6,13). Similarly, there is little evidence of the use of tolvaptan in the treatment of pediatric hypervolemic hyponatremia, such as that observed in cardiac failure and nephrotic syndrome (14,15,16,17).…”

Section: Introductionmentioning

confidence: 99%

Efficiency of Single Dose of Tolvaptan Treatment During the Triphasic Episode After Surgery for Craniopharyngioma

Gürbüz

Taştan

Turan

et al. 2019

Jcrpe

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Inappropriate antidiuretic hormone syndrome (SIADH) may develop after intracranial surgery. SIADH in the pediatric age group is usually encountered in patients with an intracranial mass both before and after surgery. Fluid restriction is the standard therapy in SIADH. However, a resistant, hyponatremic pattern may be encountered in some cases. Vaptans have been recently introduced for treatment of hyponatremia due to SIADH. There is inadequate data concerning tolvaptan treatment in pediatric patients. We present a 13 year-old female with SIADH of triphasic episode who was transferred to our clinic after surgery for craniopharyngioma. Resistant hyponatremia did not resolve despite fluid restriction and hypertonic saline support. The patient responded rapidly to a single dose of tolvaptan, with no adverse effect, which resulted in successful control of her SIADH.

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Tolvaptan treatment of severe stroke-like symptoms and bilateral subcortical diffusion restriction due to syndrome of inappropriate secretion of ADH after polytrauma

Cited by 6 publications

References 6 publications

Regulation of Serum Sodium Levels during Chemotherapy Using Selective Arginine Vasopressin V2-Receptor Antagonist Tolvaptan in a Four-Year-Old Girl with a Suprasellar Germ Cell Tumor

Regulation of Serum Sodium Levels during Chemotherapy Using Selective Arginine Vasopressin V2-Receptor Antagonist Tolvaptan in a Four-Year-Old Girl with a Suprasellar Germ Cell Tumor

Tolvaptan Treatment in Children with Chronic Hyponatremia due to Inappropriate Antidiuretic Hormone Secretion: A Report of Three Cases

Efficiency of Single Dose of Tolvaptan Treatment During the Triphasic Episode After Surgery for Craniopharyngioma

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