THIS INFORMATION IS INTENDED FOR US HEALTHCARE PROFESSIONALS
ABOUT CUMBERLAND  |  IMPORTANT SAFETY INFORMATION  |  FULL PRESCRIBING INFORMATION  |  NEWS
logo
register
pdf
938KB

Mild Renal Insufficiency With Euvolemic Hyponatremia

Diagnosis

Euvolemic hyponatremia secondary to mild renal insufficiency

Why Vaprisol was chosen for treatment

In this patient with euvolemic hyponatremia and a history of both cardiac and pulmonary disease, and chronic renal insufficiency, Vaprisol was selected as treatment to raise serum sodium and to try to avoid excess sodium and fluid overload.

Initial Presentation

The patient is a 70-year-old Hispanic male with a long medical history who was brought to his physician by family members after they noted increasing fatigue, restlessness, and gait abnormalities. Laboratory tests showed a serum sodium of 123 mEq/L, indicative of hyponatremia; the patient was admitted to the hospital.*

Medical History

  • Moderate mitral regurgitation
  • Congestive heart failure (NYHA class II)
  • Hyperlipidemia
  • Chronic obstructive pulmonary disease
  • Peripheral vascular disease
  • Myocardial infarction
  • Remote history of CABG

Medications

  • Aspirin
  • Furosemide
  • Tiotropium
  • Valsartan HCT
  • Fluticasone propionate

Exam Findings

Vital Signs BP: 140/78 mm Hg, HR: 88 bpm, temperature: 98.4° F, RR: 12, weight: 172 lb
Lungs Coarse inspiratory crackles
EKG Left bundle branch block
Chest X-ray Cardiomegaly, no effusions
Other No edema
Labs Sodium 123 mEq/L, BUN/Cr 43/1.2, creatinine clearance 63 mL/min

Patient's progression from admission through day 4, and follow-up at day 11

  VITAL SIGNS LAB VALUES  
  BP
(mm Hg)
HR
(bpm)
Weight
(lb)
Urine
Output
(cc)
Serum
Osm
(osm/kg)
Urine
Na+
(mEq/L)
Serum
Na+
(mEq/L)
NOTES
Upon
Admission
130/60 72 172 265 20 123 A loading dose of Vaprisol 20-mg IV administered over 30 minutes, followed by a 20-mg continuous IV infusion administered over 24 hours and fluid restriction to 1 L/day
Day 1 130/66 76 170 2400 279 25 128 A 40-mg continuous IV infusion of Vaprisol administered over 24 hours
Day 2 132/64 70 170 2000 291 33 131 A 40-mg continuous IV infusion of Vaprisol administered over 24 hours
Day 3 136/68 66 170 1200 280 33 133 Vaprisol discontinued
Day 4 280 28 Fluid restriction 1 L/day; discharged
Follow-up
Day 11
136/70 64 170 138 138 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.