eISSN: 2345-2781  
J Renal Inj Prev. 2018;7(2):98-102.
doi: 10.15171/jrip.2018.23

Case Report

Symptomatic life-threating hyponatremia complicating severe COPD exacerbation, pulmonary edema and pulmonary hypertension-a critical role for conivaptan 

Macaulay Amechi Chukwukadibia Onuigbo 1,2 * , Muhammad A Rishi 3, Nneoma Agbasi 4, Mark Henry Alon 5, Yasser Sammour 6, Thuyanh Culver 5, Adel Zurob 3, Abdul Khan 2, Emeka Amadi 5

1 Mayo Clinic College of Medicine, Rochester, MN, USA
2 Department of Nephrology, Mayo Clinic Health System, Eau Claire, WI, USA
3 Department of Pulmonary and Critical Care Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
4 Practice Improvement Team, NELFT NHS Foundation Trust, Basildon, Essex, UK
5 Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
6 Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Macaulay Amechi Onuigbo Email: onuigbo.macaulay@mayo.edu

Abstract

Hyponatremia, the most common electrolyte abnormality in hospitalized patients, is associated with increased morbidity and mortality. Phase 3 clinical trials and subsequent studies including the Study of Ascending Levels of Tolvaptan in Hyponatremia 1 and 2 (SALT 1 and 2) clearly demonstrated the efficacy of vasopressin antagonists in increasing plasma sodium levels. The "vaptans", oral tolvaptan and intravenous conivaptan, are vasopressin antagonists but as recently as 2015, there remained conflicting recommendations for their use by different expert committees in patients with hyponatremia. This circumstance was blamed on limited patient experiences and limited research data. We recently encountered worsening life-threatening symptomatic hyponatremia, unresponsive to hypertonic 3% saline infusion, and impending respiratory failure in a 62-year old obese Caucasian male patient who was further complicated by advanced chronic obstructive pulmonary disease (COPD), pulmonary hypertension and acutely decompensating diastolic heart failure, albeit with stable CKD II creatinine levels. Intravenous loop diuretics may have helped with heart failure but potentially would have aggravated the already critically low sodium levels. He demonstrated a brisk response to intravenous conivaptan administration. Intravenous conivaptan is sine qua non the absolute ideal therapeutic agent for acutely decompensating congestive heart failure with concurrent life-threatening hyponatremia.
Please cite this paper as: Onuigbo MAC, Rishi MA, Agbasi N, Alon MH, Sammour Y, Culver T, et al. Symptomatic lifethreating hyponatremia complicating severe COPD exacerbation, pulmonary edema and pulmonary hypertension-a critical role for conivaptan. J Renal Inj Prev. 2018;7(2):98-102. DOI: 10.15171/jrip.2018.23.
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