What are the guidelines regarding the treatment of hyponatremia with inappropriate antidiuretic hormone secretion (SIADH)?

Updated: Jun 17, 2019
  • Author: Eric E Simon, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

For patients with inappropriate antidiuretic hormone secretion (SIADH), fluid restriction (with a goal of 500 mL/d below the 24-hour urine volume) is generally first-line therapy, but pharmacologic treatment should be strongly considered if the patient's urinary parameters indicate low renal electrolyte-free water excretion or if the serum sodium concentration does not correct after 24-48 hours of fluid restriction. Pharmacologic options include demeclocycline (off label use), urea, and vasopressin receptor antagonists (vaptans). Vaptans should not be used in hypovolemic hyponatremia, or in conjunction with other treatments for hyponatremia. [34]


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