What are the recent advances in the management of hyponatremia?

The selective vasopressin (V2) receptor antagonists conivaptan (IV) and tolvaptan (oral) are relatively new treatment options for severe or resistant hyponatremia. These drugs are to be used with caution because they may correct serum Na concentration too rapidly; they are typically reserved for severe (<120 mEq/L) and/or symptomatic hyponatremia that is resistant to correction with fluid restriction and for short-term use. The same rate of correction as for fluid restriction, ≤10 mEq/L over 24 hour, is used. These drugs should not be used for hypovolemic hyponatremia or in advanced chronic kidney disease.