Hyponatremia is one of the most common
electrolyte abnormalities encountered in the clinical setting in hospitalized patients. The syndrome of inappropriate
antidiuretic hormone secretion (
SIADH) is the leading cause of
hyponatremia in most of these cases. While fluid restriction, hypertonic saline infusion,
diuretics, and the treatment of underlying conditions constitute the first line of treatment of
SIADH, in refractory cases, and especially for pediatric patients, there seems not to be any other choice for treatment.
Tolvaptan, although its use in pediatric patients is still very limited, might be an attractive treatment option for correction of
hyponatremia due to
SIADH. Here we present a pediatric case of
SIADH that was resistant to treatment with fluid restriction and hypertonic saline infusion and was treated successfully with
tolvaptan.
Tolvaptan could be a good, safe, and effective treatment option in pediatric
SIADH cases that are resistant to treatment. However, the dosage should be titrated carefully.