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Conivaptan increases serum sodium in hyponatremic patients with end‐stage liver disease
Author(s) -
O'Leary Jacqueline G.,
Davis Gary L.
Publication year - 2009
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21836
Subject(s) - medicine , hyponatremia , liver transplantation , discontinuation , liver disease , gastroenterology , transplantation , hyperkalemia , perioperative , stage (stratigraphy) , surgery , paleontology , biology
Abstract Hyponatremia is associated with increased mortality in patients with end‐stage liver disease and a greater risk of perioperative mortality with liver transplantation. We performed a retrospective review of our experience with conivaptan as a means of acutely increasing serum sodium in end‐stage liver disease patients. The primary group consisted of 15 patients with end‐stage liver disease who remained hyponatremic despite discontinuation of diuretics and a 1‐L fluid restriction. Twenty milligrams of conivaptan was intravenously administered over 30 minutes, and this was followed by an infusion of 20 mg over 24 hours for 1 to 4 days. A second group of 9 hyponatremic end‐stage liver disease patients was treated with 1‐L fluid restriction and conivaptan while remaining on diuretics. In the group without diuretics, the mean serum sodium was 124 mmol/L 1 day before and on the day of conivaptan initiation, but the serum sodium rose to a mean of 127.7 mmol/L by day 1 and further increased to 128.6 mmol/L by the second day of the infusion. Despite the continuation of diuretics, the second group of 9 patients also had an increase in serum sodium from the day of conivaptan initiation (125.7 mmol/L) to 2 days after the treatment (130.6 mmol/L). Eleven patients underwent successful liver transplantation, 2 remained on the list for transplantation, and 11 were not candidates for transplantation and either died (7) or were discharged home and lost to follow‐up (4). In conclusion, a short course of conivaptan increases serum sodium in patients with end‐stage liver disease and may reduce the risk of proceeding to liver transplantation. Further study in a prospective clinical trial is needed to confirm safety and efficacy. Liver Transpl 15:1325–1329, 2009. © 2009 AASLD.