As it can be challenging for families in the grieving process to make timely decisions that respect the patients wishes and values, having an established advanced care directive in place can prevent over-treatment, under-treatment, or further complications in treatment management.Patients and families may also struggle to grasp the inevitability of death, and the differing risks and effects of medical and non-medical interventions available for end-of-life care. A systematic literature review reviewing the frequency of end-of-life care conversations between COPD patients and clinicians found that conversations regarding end-of-life care often occur when a patient has advanced stage disease and occur at a low frequency. To prevent interventions that are not in accordance with the patients wishes, end-of-life care conversations and advanced care directives can allow for the care they desire, as well as help prevent confusion and strain for family members. Signs of dying
The National Cancer Institute in the United States (US) advises that the presence of some of the following signs may indicate that death is approaching:
Drowsiness, increased sleep, and/or unresponsiveness (caused by changes in the patients metabolism). Confusion about time, place, and/or identity of loved ones; restlessness; visions of people and places that are not present; pulling at bed linen or clothing (caused in part by changes in the patients metabolism). Decreased socialization and withdrawal (caused by decreased oxygen to the brain, decreased blood flow, and mental preparation for dying).
When using to treat hyponatremia, it may cause too rapid correction of hyponatremia resulting in fatal osmotic demyelination syndrome. Pharmacology
Tolvaptan is a selective vasopressin V2 receptor antagonist. Chemistry
Tolvaptan is a racemate, a 1:1 mixture of the following two enantiomers:

References
Further reading
Gheorghiade M, Niazi I, Ouyang J,  et al. (2003). "Vasopressin V2-receptor blockade with tolvaptan in patients with chronic heart failure: results from a double-blind, randomized trial". Circulation. 107 (21): 2690–6. doi:10.1161/01.CIR.0000070422.41439.04. PMID 12742979. External links
"Tolvaptan". Drug Information Portal. U.S. National Library of Medicine.