Dotted lines represent targets based on expert guidelines. No significant differences at any time point. C: conivaptan; HS: … Figure 3. Incidence of [Na+] over-correction based on expert guidelines. No significant differences at any time point. C: conivaptan; HS: 3% saline. A small percentage of patients received 5% Selleck Autophagy Compound Library dextrose in water shortly after the administration of either HS (n=3, 8.8%) or conivaptan (n=4, 26.7%), and there was no difference in the incidence of [Na+] over-correction between HS and conivaptan groups related to administration of dextrose water. Discussion With an estimated

incidence of 1% and prevalence of 2.5%, hyponatremia Inhibitors,research,lifescience,medical is the most common electrolyte abnormality in clinical practice and, as such, is often encountered by primary care and subspecialty physicians, e.g., nephrologists, geriatricians, endocrinologists, etc.13 Optimal management of hyponatremia is evolving. In the setting of symptomatic Inhibitors,research,lifescience,medical hyponatremia, treatment options include HS and conivaptan. A known benefit of HS is that it is less expensive.14 However, it carries the risk of volume overload in oliguric or anuric patients, and guidelines for rates of infusion have been criticized for posing a risk of underestimating

an increase in [Na+], particularly in the setting of extracellular volume depletion Inhibitors,research,lifescience,medical where normal saline is the crystalloid of choice. Conversely, conivaptan treatment involves a significantly lower volume of medication but carries a higher cost.14 These are factors that must be considered when deciding which agent to use in treating euvolemic or hypervolemic hyponatremia. In a retrospective analysis of patients treated with HS or conivaptan for hyponatremia, no significant Inhibitors,research,lifescience,medical differences were identified in adherence to treatment guidelines established in 2007 by expert panel recommendations.4 Although drawn from a small sample size originating from a single center, to our knowledge this study is the first to compare the effect of HS Inhibitors,research,lifescience,medical and conivaptan intervention for the management

of hyponatremia in a sample of population otherwise similar in all parameters evaluated. Findings of the present study suggest that neither agent poses a significant risk of over-correction at 4, 24, or 48 hours regardless of whether the patient is euvolemic or hypervolemic. This must be tempered by the fact that in this retrospective study, it was found that 73.3% of the patients receiving Microbiology and Molecular Biology Reviews conivaptan received it as a continuous infusion with the recommended loading dose whereas the remainder of the patients did not. This may be due to the fact that the prescribing conivaptan was available to any attending-level physician at our institution, regardless of department. The observed rate of mean [Na+] correction with conivaptan at 4 (2.9 mEq/L) and 24 (7.7 mEq/L) hours in this study is consistent with previously published findings of 2–3.5 mgEq/L and 6–8 mEq/L, respectively. However, the rate of correction at 12 (5.7 mEq/L) and 48 (10.