Vasopressin receptor antagonist use in a neurologic rehabilitation center.

Background/objective: To report successful use of a modified protocol of vasopressin receptor antagonist for effective and safe treatment of hyponatremia in a complexly ill patient in the neurorehabilitation setting.

Design: Case report.

Participants/methods: A 57-year-old man with tetraparesis and protracted hyponatremia resistant to standard therapies.

Results: This patient's rehabilitation from epidural abscess-induced tetraplegia was complicated by symptomatic hyponatremia. The pathophysiology was multifactorial. The course was prolonged, and several therapeutic endeavors failed. Intravenous infusions of vasopressin receptor antagonist induced and maintained eunatremia. The pace of the patient's recovery improved, and he was discharged with substantial neurologic recovery. No central nervous system toxicities of the treatments were observed.

Conclusion: Intravenous vasopressin receptor antagonist is an effective and safe treatment for hyponatremia in the rehabilitation setting if the dosage and monitoring protocols are modified in accordance with the physiology of the patient with spinal cord injury.