Key result
IV conivaptan rapidly resolves severe hyponatremia and pulmonary edema in decompensated heart failure.
Why the study?
There was limited patient experience and research data on the use of vasopressin antagonists for severe symptomatic hyponatremia complicating advanced COPD, pulmonary hypertension, and acutely decompensating heart failure.
Case Report (n=1)
May facilitate aquaresis in refractory hyponatremia with HF and COPD; leaves open prospective validation.
Implication for health policy/practice/research/medical education:We report a 62-year-old obese hypertensive Caucasian male patient with advanced COPD, pulmonary hypertension and acutely decompensating diastolic heart failure who presented with severe symptomatic life-threatening hyponatremia.Hypertonic 3% saline infusion did not improve hyponatremia even at 40 cc/h infusion rate and the patient was quickly experiencing worsening pulmonary edema with respiratory distress and imminent need for ventilatory support.The swift use of intravenous conivaptan, a vasopressin antagonist, with close 4-hourly monitoring of the serum sodium levels resulted in a prompt aquaresis with resolution of symptoms of pulmonary edema, fluid retention and simultaneous correction of life-threatening symptomatic hyponatremia.Vasopressin antagonists can be a life-saving therapeutic option in such critical clinical circumstances.
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Onuigbo et al. (2018) conducted a case report in Severe hyponatremia complicating severe COPD exacerbation and heart failure (n=1). Intravenous conivaptan was evaluated on Serum sodium correction and resolution of pulmonary edema. Intravenous conivaptan rapidly corrected life-threatening hyponatremia (117 to 132 mmol/L) and resolved pulmonary edema through prompt aquaresis in a male with severe COPD and heart failure.
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