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Schrier RW, Gross P, Gheorghiade M, et al for the SALT investigators. Tolvaptan, a selective oral vasopressin V2-receptor antagonist for hyponatremia. N Engl J Med 2006;355:2099–112.
When hyponatremia develops in patients with decompensated cirrhosis or heart failure, this not only heralds poor prognosis, but also severely limits the treatment options making even symptom control difficult to achieve. Fluid restriction in these patients is illogical and usually ineffective. Schrier et al, designed two multi-centre randomised, double-blind, placebo-controlled trials to evaluate the efficacy of oral selective vasopressin V2-receptor antagonist in the treatment of hyponatremia (serum sodium <135 mmol/l). The two trials were identical in design and were conducted at 42 sites in the US (SALT-1) and 50 international sites (SALT-2). Of 448 randomised patients with euvolemic hyponatremia, 120 had cirrhosis, 138 heart failure and 190 had syndrome of inappropriate antidiuretic hormone secretion. Within 8 h of
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