Edematous Hyponatremia Treated with Tolvaptan in a Patient with Amyotrophic Lateral Sclerosis

다국어 초록 (Multilingual Abstract)

Amyotrophic lateral sclerosis (ALS) patients rarely present with either syndrome of inappropriate antidiuretic hormone secretion or generalized edema. Tolvaptan is a selective vasopressin V2 receptor antagonist that produces effective aquaresis, and its use in ALS patients has not been previously reported. A 50-year-old male ALS patient was admitted because of both generalized edema and dilutional hyponatremia. These manifestations were refractory to conventional diuretics and fluid therapy, but a very brisk diuresis was induced by tolvaptan administration. Edema and hyponatremia were also improved, and the patient was able to be discharged without tolvaptan. In this case report, we postulate how edema and dilutional hyponatremia developed in the patient, and discuss the mechanism of tolvaptan in treating hypervolemic hyponatremia. Further experience is necessary to evaluate the usefulness of tolvaptan in patients with neurological disorders.

참고문헌 (Reference)

1 Ecelbarger CA, "Vasopressin-mediated regulation of epithelial sodium channel abundance in rat kidney" 279 : F46-F53, 2000

2 Miranda CA, "Tolvaptan as a tool in renal physiology" 306 : F359-F366, 2014

3 Yoshida Y, "Syndrome of inappropriate secretion of antidiuretic hormone associated with amyotrophic lateral sclerosis in respiratory failure" 4 : 185-187, 1999

4 Yui Inoue, "Syndrome of inappropriate antidiuretic hormone secretion associated with amyotrophic lateral sclerosis in a patient developing carbon dioxide narcosis" 56 : 797-803, 2017

5 Jackson CE, "Symptom Management and End-of-Life Care in Amyotrophic Lateral Sclerosis" 33 : 889-908, 2015

6 Oey PL, "Subtle involvement of the sympathetic nervous system in amyotrophic lateral sclerosis" 25 : 402-408, 2002

7 Perucca J, "Sodium excretion in response to vasopressin and selective vasopressin receptor antagonists" 19 : 1721-1731, 2008

8 Jujo K, "Randomized pilot trial comparing tolvaptan with furosemide on renal and neurohumoral effects in acute heart failure" 3 : 177-188, 2016

9 Miller RG, "Quality Standards Subcommittee of the American Academy of Neurology: Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: multidisciplinary care, symptom management, and cognitive/behavioral impairment (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology" 73 : 1227-1233, 2009

10 Sladen A, "Pulmonary complications and water retention in prolonged mechanical ventilation" 279 : 448-453, 1968

11 Park ES, "Is tolvaptan indicated for refractory oedema in nephrotic syndrome?" 20 : 103-106, 2015

12 Rosenow EC 3rd, "Inappropriate antidiuretic hormone secretion in pneumonia" 47 : 169-174, 1972

13 Boer PA, "Early altered renal sodium handling determined by lithium clearance in spontaneously hypertensive rats (SHR): role of renal nerves" 76 : 1805-1815, 2005

14 Tanaka A, "Different effects of tolvaptan in patients with idiopathic membranous nephropathy with nephrotic syndrome" 56 : 191-196, 2017