Table 1 Indications for Tolvaptan Initiation

Tolvaptan – Initial usage policy

ᅟ1) Confirm SIADH (See Fig. 1a) AND

ᅟ2) Na <125 despite 48 h fluid restriction at 750 ml/24 h or

ᅟ3) Na <125 and falling despite 24 h fluid restriction @ 750 ml/24 h or

ᅟ4) Symptoms/risks associated with 2) or 3) awaiting for Chemotherapy

At initiation of Tolvaptan

ᅟ1) Stop fluid restriction (allow patient to drink when thirsty)

ᅟ1) Monitor Na levels 6hrly for 36 h then 12hrly

ᅟ1) Review Tolvaptan use at 3, 6 and 9 days

ᅟ1) If Na rises by >6 at 6 h, >8 mmol/L in 12 h, >12 mmol/L in 24 h or >18 in 48 h OR if Na >126, STOP Tolvaptan and continue to monitor Na 12hrly for 36 h – Consider 5% Dextrose.