PMC3912886_01
Effect of tolvaptan on serum sodium levels.
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Table 1.) Due to hyponatremia aggressive diuresis was done and as there was no rise in serum sodium levels, tolvaptan 15 mg was started on hospital day 6. The patient showed improvement after receiving the first dose of tolvaptan and on hospital day 7 his serum sodium was 126 mmol/L (see Figure 1).
Effect of tolvaptan on serum sodium and urine output. The dotted rectangle shows the exposure to Tolvaptan from day 6 to day 9.
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At this point, tolvaptan was stopped. (The effects of tolvaptan on serum sodium levels and urine output have been shown in Figure 2.) The patient developed signs of osmotic demyelination syndrome which failed to resolve after rapid correction with hypotonic fluids and desmopressin and was transferred to the medical intensive care unit for further management of hypernatremia.