How is euvolemic hyponatremia treated, and how is concomitant hypokalemia and hyponatremia addressed?

Updated: Aug 24, 2020
  • Author: Kartik Shah, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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In April 2013, the FDA limited use of tolvaptan to no more than 30 days and indicated that it should not be used in patients with underlying liver disease. This decision was based on reports of liver injury, including those potentially leading to liver transplant or death. [34]

Euvolemic hyponatremia implies normal sodium stores and a total body excess of free water. Treatment consists of free water restriction and correction of the underlying condition. Recently developed AVP (vasopressin) receptor antagonists (eg, conivaptan, tolvaptan) show promise as effective and well-tolerated intravenous therapy for SIADH. Further studies are needed to better define their role in the treatment of hyponatremia associated with SIADH. [35]

Special consideration must be given to patients with concomitant hypokalemia and hyponatremia. With potassium repletion, intracellular shifts cause plasma sodium to increase. Consequently, the potassium repletion must be taken into account as patients undergo hypertonic saline therapy, and appropriate downward adjustment of the hypertonic saline dosage should be made. [36]

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