5–8 mEq/L, respectively.2, 15-17 This may be explained by the small sample size of our study. This study has a number of limitations, including its small sample size, retrospective design, ethnic homogeneity, absence of post-treatment follow-up to monitor potential complications (e.g., ODS), and loss of data at later time points after initiation of treatment. In addition, although both treatments were shown to be comparable regarding the rate of sodium correction, they were comparably slow. A

further limitation of the study is that the majority of patients had surgical, neurological, or neurosurgical conditions, constituting a complex patient population. Inhibitors,research,lifescience,medical It is possible that the results from these patients may differ from those of a different inpatient population. A meta-analysis of randomized Inhibitors,research,lifescience,medical controlled trials comparing vasopressin receptor antagonist use to placebo or no treatment in the setting of hyponatremia showed that, within 3–7 days of initiating therapy, the [Na+] correction of vasopressin antagonists was significantly increased (5.27 mEq/L) compared to the control, and the relative risk of rapid [Na+] overcorrection (2.52) was significant with vasopressin antagonists without significantly increasing the rate of hypernatremia.18 Since the most serious criticism of early formulae suggesting

hyponatremia Inhibitors,research,lifescience,medical correction rates is that they fail to account for ongoing fluid and electrolyte losses, and therefore underestimate actual increases in [Na+], additional retrospective or prospective analyses using newer formulae are warranted. Future studies focusing on the adherence Inhibitors,research,lifescience,medical of HS and conivaptan to expert guidelines in the treatment of hyponatremia should include a larger sample size; they also should analyze the extent to which prescribed rates of HS IV administration Inhibitors,research,lifescience,medical are derived from accurate calculations of patients’ ideal body weight or the extent to which conivaptan infusion rates adhere to manufacturer-established prescription rates.4 Although the focus of this study was not to assess the accuracy

of commonly used formulas to predict a rise in [Na+] or to assess the accuracy of established prescription dosages for conivaptan, prescribed rates for administering HS were not uncommonly lower than PD184352 (CI-1040) those calculated by the Adrogué-Madias formula. This may partly explain the paucity of over-correction among patients GSK343 treated with HS. The rationale of the prescribing physicians’ orders for a lower rate of HS than that suggested by the Adrogué-Madias formula is unclear — assuming goal [Na+] at interval points of 2 to 4 mEq/L within 2 to 4 hours, <12 mEq/L in 24 hours, and to <18 mEq/L in 48 hours; however, caution is advised in using these formulae in clinical care, as there is no consensus on a universally adopted standard of care but only guidelines to achieve normonatremia. Perhaps the observed lower infusion rate of HS was prescribed in response to recommendations made in previous studies.