TOPIC DISCUSSION: Cirrhosis, Hyponatremia and the role of Vaptans?

CHF and SIADH has clear indications for use of vaptans. What is the data and evidence in cirrhosis associated hyponatremia?


1. No drug has been approved to treat hyponatremia of cirrhotics as of yet
2. Studies from Europe using lixivaptan and satavaptan have shown that short term effects of using them have had increased serum NA levels in cirrhotics and sustained for 1-2 weeks.
3. Unfortunately , only 27-54% had complete normalization of the Na
4. All studies showed increased urinary Na levels
5. Only one study has shown long term effects of captains in cirrhotics and that is using satavaptan. 
The main finding was that the improvement in serum Na obtained in first days of therapy was maintained for one year.
6. Thirst was the biggest side effect.
7. To avoid rapid correction, use of D5W after reaching a certain threshold and matching urine output cc by cc is recommended as risk of ODS is there but not been reported thus far.
8. Patients awaiting liver transplantation should get treatment for Hyponatremia as there have been situations were Na corrects rapidly as the transplant is replaced and subsequently causing neurological sequelae. 


Ref:
http://onlinelibrary.wiley.com/doi/10.1002/hep.22418/pdf
http://www.ncbi.nlm.nih.gov/pubmed/19797900
http://www.ncbi.nlm.nih.gov/pubmed/12671890

http://www.ncbi.nlm.nih.gov/pubmed/18508290

Interesting Urine Lytes

1. Oliguric/anuric individual
Urine lytes obtained after foley inserted:- Una 27, UK 24, UCl 27 and U Crt 9

2. Hyponatremic individual Na 107, conivaptan stated
Urine lytes obtained after 4 hours:- Una <10, UK<10 U Cl <10 and U Osm 150

Any thoughts? on what is going on?