Tuesday, November 26, 2019

Controlled aquaresis

PulmCrit (EMCrit)
PulmCrit- November 26, 2019 - By Josh Farkas
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"Summary The Bullet:

  • Oral urea therapy is finally available in the United States. Urea functions as an osmotic diuretic (a.k.a. aquaretic), with potential use in euvolemic or hypervolemic hyponatremia.
  • No RCTs exist comparing oral urea to alternative therapies (e.g. vaptans). However, oral urea is widely regarded as very safe (it’s classified by the FDA as a “medicinal food”). An emerging body of evidence suggests that oral urea is a safe and effective therapy for many forms of hyponatremia.
  • Although oral urea is perceived as a “new” therapy in the United States, it has been used for decades in Europe. For example, urea was recommended for management of SIADH in the 2014 European guidelines.​
  • Oral urea has important advantages compared to vaptans: it is cheaper and will not cause uncontrolled excretion of free water (thus, urea is unlikely to cause osmotic demyelination syndrome and requires less intensive monitoring than vaptans)."