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lüll Conivaptan increases serum sodium in hyponatremic patients with end-stage liver disease O'Leary JG; Davis GLLiver Transpl 2009[Oct]; 15 (10): 1325-9Hyponatremia is associated with increased mortality in patients with end-stage liver disease and a greater risk of perioperative mortality with liver transplantation. We performed a retrospective review of our experience with conivaptan as a means of acutely increasing serum sodium in end-stage liver disease patients. The primary group consisted of 15 patients with end-stage liver disease who remained hyponatremic despite discontinuation of diuretics and a 1-L fluid restriction. Twenty milligrams of conivaptan was intravenously administered over 30 minutes, and this was followed by an infusion of 20 mg over 24 hours for 1 to 4 days. A second group of 9 hyponatremic end-stage liver disease patients was treated with 1-L fluid restriction and conivaptan while remaining on diuretics. In the group without diuretics, the mean serum sodium was 124 mmol/L 1 day before and on the day of conivaptan initiation, but the serum sodium rose to a mean of 127.7 mmol/L by day 1 and further increased to 128.6 mmol/L by the second day of the infusion. Despite the continuation of diuretics, the second group of 9 patients also had an increase in serum sodium from the day of conivaptan initiation (125.7 mmol/L) to 2 days after the treatment (130.6 mmol/L). Eleven patients underwent successful liver transplantation, 2 remained on the list for transplantation, and 11 were not candidates for transplantation and either died (7) or were discharged home and lost to follow-up (4). In conclusion, a short course of conivaptan increases serum sodium in patients with end-stage liver disease and may reduce the risk of proceeding to liver transplantation. Further study in a prospective clinical trial is needed to confirm safety and efficacy.|Adult[MESH]|Aged[MESH]|Benzazepines/*pharmacology[MESH]|Drug Administration Schedule[MESH]|Female[MESH]|Humans[MESH]|Hyponatremia/*blood/*drug therapy[MESH]|Liver Failure/*drug therapy/*pathology[MESH]|Liver Transplantation/methods[MESH]|Male[MESH]|Middle Aged[MESH]|Retrospective Studies[MESH]|Risk[MESH]|Sodium/*blood[MESH]|Time Factors[MESH]|Treatment Outcome[MESH] |