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Preoperative Euvolemic Hyponatremia in a Burn Patient

Diagnosis

Thiazide-induced euvolemic hyponatremia with associated hypochloremia

Why Vaprisol was chosen for treatment

  • Patient required prompt surgery to treat burn wounds and minimize burn-related morbidities
  • Due to the presentation of euvolemic hyponatremia and the potential for significant complications such as acute seizure disorder, general anesthesia was contraindicated
  • Hyponatremia was determined to be thiazide-induced; alcohol (ETOH) dependency was considered negligible
  • Vaprisol blocks the V2 receptors in the collecting ducts of the kidneys, resulting in aquaresis, and the raising of serum sodium levels
  • Vaprisol treatment was started on the medical floor; within 24 hours serum sodium levels were raised to near normal, allowing rapid transfer to the operating room (OR)

Initial Presentation

A 42-year-old white male was admitted to the Burn Unit with 15% Total Body Surface Area (TBSA) deep-partial thickness burns to his upper and lower extremities resulting from misuse of an accelerant. There was no evidence of trauma, inhalation injury, or loss of consciousness. The patient was intoxicated when the injury occurred.

Medical History

  • Essential hypertension
  • Alcohol (ETOH) dependency

Medications

  • Hydrochlorothiazide (HCTZ) 25-mg daily for the last 2 years

Exam Findings

Vital Signs Weight: 160 lb, Temperature: 99.0°F, BP: 150/90 mm Hg, HR: 100 bpm, RR: 18
Chest X-ray No acute changes, chronic obstructive lung disease pattern
EKG Normal sinus rhythm at 100, nonspecific ST-T wave changes and voltage criteria for left ventricular hypertrophy (LVH). Remainder unremarkable.

Patient's progression from admission to discharge at day 4

  VITAL SIGNS LAB VALUES  
  BP
(mm Hg)
HR
(bpm)
Weight
(lb)
Urine
Output
(cc/hour)
Serum
Osmolality
(mOsm/kg-H2O)
Urine
Na+
(mEq/L)
Serum
Na+
(mEq/L)
NOTES
Upon
Admission
Day 0
150/90 100 160 30 405 201 126 Patient diagnosed with euvolemic hyponatremia based on laboratory findings. Patient first received normal saline solution, then a loading dose of Vaprisol 20-mg IV was administered over 30 minutes, followed by a 20-mg continuous IV infusion to be administered over 24 hours.
Day 1 130/72 90 160 60 134 Patient admitted to the OR. A 20-mg continuous IV infusion of Vaprisol was administered over 24 hours, including during the procedure.
Day 2 136/78 84 160 50 208 80 138 A 20-mg continuous IV infusion of Vaprisol administered over 24 hours.
Day 3 137 Vaprisol infusion discontinued
Day 4 139 Serum sodium level maintained within normal range*; patient discharged to his home.

*The effect of Vaprisol on the maintenance of serum sodium concentration is not known.1



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