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Syndrome of inappropriate secretion of antidiuretic hormone in traumatic brain injury: when tolvaptan becomes a life saving drug
  1. Giorgio Graziani1,
  2. David Cucchiari1,
  3. Adriana Aroldi2,
  4. Claudio Angelini1,
  5. Paolo Gaetani3,
  6. Carlo Selmi4
  1. 1Department of Medicine, Nephrology and Dialysis Unit, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy
  2. 2Department of Medicine, Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
  3. 3Department of Neurology, Neurosurgery Unit, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy
  4. 4Department of Medicine, Autoimmunity and Metabolism Unit, IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy
  1. Correspondence to Professor G Graziani, Istituto Clinico Humanitas IRCCS, Via Manzoni, 56 20089 Rozzano, MI, Italy; giorgio.graziani{at}


Objective To outline the role of a new drug, tolvaptan, in treating severe and chronic hyponatraemia. Tolvaptan decreases aquaporin expression in renal collecting ducts, by inhibiting antidiuretic hormone (ADH)-V2 receptors, to promote free water clearance. Given its mechanism of action, this drug seems the ideal treatment for the syndrome of inappropriate antidiuretic hormone secretion (SIADH) when the osmotic imbalance leads to life threatening complications.

Data sources A case is described of severe hyponatraemia deriving from SIADH secondary to meningoencephalitis in a patient admitted to hospital for traumatic brain injury.

Data extraction Clinical, laboratory and radiological data at presentation and for a 1 year of follow-up were analysed.

Data synthesis Tolvaptan ameliorated hyponatraemia, brain oedema and consciousness, and drug withdrawal led to recurrence of hyponatraemia and coma.

Conclusions In patients with SIADH, which is not self-limited, and is associated with severe cognitive impairment, the use Tolvaptan may prove life saving and should be rigorously evaluated.

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.