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Geriatric Patient With Euvolemic Hyponatremia

Diagnosis

Euvolemic hyponatremia secondary to pneumonia in an elderly patient*

Why Vaprisol was chosen for treatment

In this patient with euvolemic hyponatremia and a history of hypertension, Vaprisol was selected as treatment to raise serum sodium and to try to avoid excess sodium and fluid overload. Fluid restriction alone might suffice to treat the hyponatremia but it can take up to a week to manage the patient's water/sodium balance.

Initial Presentation

The patient is an 82-year-old white male admitted to the hospital from a nursing home with 2 to 3 days of increasing confusion and a cough.

Medical History

  • Hypertension
  • Gout

Medications

  • Hydrochlorothiazide
  • Allopurinol
  • Propanolol

Exam Findings

Vital Signs BP: 126/62 mm Hg, HR: 90 bpm without orthostatic changes, temperature: 100.2° F, RR: 14
Mental Status Patient was oriented to person, place, and time but appeared confused about the timelines of recent events
Lungs Rhonchi and slight wheezing noted on auscultation of left lower lobe
EKG NSR with evidence of left ventricular hypertrophy
Chest X-ray Infiltrate noted in left lower lobe. No evidence of pleural effusion or increased pulmonary vasculature
Other No pedal edema

Patient's progression from admission through follow-up at day 10

  VITAL SIGNS LAB VALUES  
  BP
(mm Hg)
HR
(bpm)
Weight
(lb)
Urine
Output
(cc)
Urine
Osmolality
(mOsm/kg-H20)
Urine
Na+
(mEq/L)
Serum
Na+
(mEq/L)
NOTES
Upon
Admission
126/62 90 180 655 57 124 Broad spectrum antibiotics started. A loading dose of Vaprisol 20-mg IV administered over 30 minutes was followed by a 20-mg continuous infusion administered over 24 hours
Day 1 130/60 76 179 2400 128 20-mg Vaprisol IV infusion administered over 24 hours
Day 2 132/64 70 178 1700 164 9 132 20-mg Vaprisol IV infusion administered over 24 hours. Patient switched to oral antibiotics based on sputum culture results
Day 3 136/68 66 178 1200 103 10 136 Fluid restriction 1 L/day; discharged to nursing home
Follow-up
Day 10
136/70 64 178 138 Patient no longer restricting fluids

*In clinical studies of Vaprisol, the adverse event profile in elderly patients was similar to that seen in the general population.1



REFERENCE: 1. Vaprisol Prescribing Information. Cumberland Pharmaceuticals Inc.