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Tolvaptan in a pediatric patient with diuretic‐resistant heart and kidney failure
Author(s) -
Hirano Daishi,
Kakegawa Daisuke,
Yamada Akifumi,
Ito Akira,
Miwa Saori,
Ida Hiroyuki
Publication year - 2015
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.12590
Subject(s) - medicine , tolvaptan , furosemide , diuretic , heart failure , oliguria , spironolactone , volume overload , hyponatremia , diuresis , renal function , intravascular volume status , kidney disease , cardiology , acute decompensated heart failure , edema , intensive care medicine , hemodynamics
Despite conventional diuretic therapy, volume overload persists in many patients with decompensated heart failure. Adverse effects of diuretics are common, including worsening kidney function and electrolyte disturbance. Furthermore, decreased kidney function also affects the response to diuretics and is associated with an increased risk of mortality. A 10‐year‐old boy with congestive heart failure ( CHF ) complicated by advanced chronic kidney disease ( CKD ) presented with oliguria and generalized edema. He was being treated with furosemide and spironolactone, and these doses were increased to 3 mg/kg/day after admission. Although edema decreased temporarily, the symptoms worsened and furosemide resistance developed 2 months later. Tolvaptan (0.1 mg/kg/day) was started, resulting in a gradual increase in the plasma sodium level and adequate decongestion of the volume overload state. Cardiac function also improved. The use of tolvaptan should be considered in pediatric cases of conventional diuretic‐resistant CHF , even when complicated by advanced CKD .