ESPN 53rd Annual Meeting

ESPN 2021


 
Pharmacological approaches in paediatric SIADH: tolvaptan and urea
FAIDRA VELIGRATLI 1 DEMITRA ALEXANDROU 1 ADEOLA FAMUBONI 1 SERGIO CAMILO LOPEZ-GARCIA 1 DETLEF BOCKENHAUER 1

1- GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST
 
Introduction:

The first step in the management of the syndrome of inappropriate antidiuretic hormone (SIADH) is fluid restriction. This can be challenging, as patients with SIADH not only tend to be thirsty but may occasionally not tolerate restriction due to coexisting medical conditions. Data on the safety of pharmacological approaches are needed to guide clinical care in paediatric SIADH. Our objective was to review the efficacy and safety of tolvaptan and urea in paediatric patients with a clinical diagnosis of SIADH. 

Material and methods:

Patients were identified from pharmacy electronic records based on their tolvaptan and urea prescriptions. The prospectively collected electronic patient records during the inpatient stay were reviewed and relevant information and laboratory results were extracted. 

Results:

We identified 14 patients who had received tolvaptan and /or urea as part of their routine clinical care for treatment of SIADH. The majority of patients were under the care of the paediatric oncology team (12/14, 86%). Tolvaptan use led to plasma sodium normalisation in 10/13 (77%) within six days (median 2.5 days, range [1,6]) with a  median change of sodium concentration of 7mmol/L (-1,14) within the first 24 hours of treatment.

 Urea use led to sodium normalisation in 5/6 (83%) patients. Median number of days to normalisation with urea was 2 (1,10) with a median change of plasma sodium concentration of 2 mmol/L (-1,6) within 24hours.  All patients tolerated tolvaptan and urea without reported side effects. Sudden sodium concentration changes in 3 patients were not associated with clinical signs or symptoms. 

Conclusions:

When fluid restriction is challenging in managing paediatric SIADH, tolvaptan and urea appear to be  safe and effective therapeutic options.