938KB
Geriatric Patient With Euvolemic Hyponatremia
Diagnosis
Euvolemic hyponatremia secondary to pneumonia in an elderly patient*
Why Vaprisol was chosen for treatment
In this patient with euvolemic hyponatremia and a history of hypertension, Vaprisol was selected as treatment to raise serum sodium and to try to avoid excess sodium and fluid overload. Fluid restriction alone might suffice to treat the hyponatremia but it can take up to a week to manage the patient's water/sodium balance.
Initial Presentation
The patient is an 82-year-old white male admitted to the hospital from a nursing home with 2 to 3 days of increasing confusion and a cough.
Medical History
- Hypertension
- Gout
Medications
- Hydrochlorothiazide
- Allopurinol
- Propanolol
Exam Findings
| Vital Signs | BP: 126/62 mm Hg, HR: 90 bpm without orthostatic changes, temperature: 100.2° F, RR: 14 |
| Mental Status | Patient was oriented to person, place, and time but appeared confused about the timelines of recent events |
| Lungs | Rhonchi and slight wheezing noted on auscultation of left lower lobe |
| EKG | NSR with evidence of left ventricular hypertrophy |
| Chest X-ray | Infiltrate noted in left lower lobe. No evidence of pleural effusion or increased pulmonary vasculature |
| Other | No pedal edema |
Patient's progression from admission through follow-up at day 10
| VITAL SIGNS | LAB VALUES | |||||||
| BP |
HR |
Weight (lb) |
Urine Output (cc) |
Urine Osmolality |
Urine Na+ |
Serum Na+ |
NOTES | |
| Upon Admission |
126/62 | 90 | 180 | — | 655 | 57 | 124 | Broad spectrum antibiotics started. A loading dose of Vaprisol 20-mg IV administered over 30 minutes was followed by a 20-mg continuous infusion administered over 24 hours |
| Day 1 | 130/60 | 76 | 179 | 2400 | — | — | 128 | 20-mg Vaprisol IV infusion administered over 24 hours |
| Day 2 | 132/64 | 70 | 178 | 1700 | 164 | 9 | 132 | 20-mg Vaprisol IV infusion administered over 24 hours. Patient switched to oral antibiotics based on sputum culture results |
| Day 3 | 136/68 | 66 | 178 | 1200 | 103 | 10 | 136 | Fluid restriction 1 L/day; discharged to nursing home |
| Follow-up Day 10 |
136/70 | 64 | 178 | — | — | — | 138 | Patient no longer restricting fluids |
*In clinical studies of Vaprisol, the adverse event profile in elderly patients was similar to that seen in the general population.1
