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Background <p>Tolvaptan-associated hyperglycemia has rarely been described in literature.</p> Case presentation <p>A 95-year-old East Asian (Chinese) male patient with hyponatremia started on tolvaptan treatment at a dosage of 15&#xa0;mg per day. The patient had a serum sodium concentration of 124.5&#xa0;mmol/L at baseline; this concentration increased to 138.3&#xa0;mmol/L over the ensuing 5&#xa0;months of treatment. Moreover, the patient’s fasting blood glucose dramatically increased from 6.3 to 17.2&#xa0;mmol/L with tolvaptan treatment, and his glycated hemoglobin A1c increased from 5.8% to 9.4%. Tolvaptan was withdrawn owing to hyperglycemia, and insulin pump treatment was started. The serum sodium concentration decreased to 123&#xa0;mmol/L after tolvaptan withdrawal. The higher levels of blood glucose, insulin, and C-peptide did not return to their previous levels for 5&#xa0;months after the withdrawal of tolvaptan.</p> Conclusion <p>We reported a rare case of tolvaptan-associated chronic severe hyperglycemia with a Naranjo probability scale score of 6. Our findings increase clinical knowledge and indicate the need for proactive blood glucose monitoring during prolonged tolvaptan use in clinical practice.</p>

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Severe tolvaptan-associated hyperglycemia: a case report

  • 期刊论文

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  • 发表日期：

    2025年7月3日

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  • Huihuan Sun,
  • Ping Yang,
  • Lijuan Chen,
  • Ying Zhang,
  • Shudong Liu,
  • Wenxiu Sun

摘要

Background

Tolvaptan-associated hyperglycemia has rarely been described in literature.

Case presentation

A 95-year-old East Asian (Chinese) male patient with hyponatremia started on tolvaptan treatment at a dosage of 15 mg per day. The patient had a serum sodium concentration of 124.5 mmol/L at baseline; this concentration increased to 138.3 mmol/L over the ensuing 5 months of treatment. Moreover, the patient’s fasting blood glucose dramatically increased from 6.3 to 17.2 mmol/L with tolvaptan treatment, and his glycated hemoglobin A1c increased from 5.8% to 9.4%. Tolvaptan was withdrawn owing to hyperglycemia, and insulin pump treatment was started. The serum sodium concentration decreased to 123 mmol/L after tolvaptan withdrawal. The higher levels of blood glucose, insulin, and C-peptide did not return to their previous levels for 5 months after the withdrawal of tolvaptan.

Conclusion

We reported a rare case of tolvaptan-associated chronic severe hyperglycemia with a Naranjo probability scale score of 6. Our findings increase clinical knowledge and indicate the need for proactive blood glucose monitoring during prolonged tolvaptan use in clinical practice.