How is syndrome of inappropriate antidiuretic hormone secretion (SIADH) treated in an emergency department (ED)?

Updated: Aug 16, 2019
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

In an emergency setting, aggressive treatment of hyponatremia should always be weighed against the risk of inducing central pontine myelinolysis (CMP). Such treatment is warranted as follows:

  • Indicated in patients who have severe symptoms (eg, seizures, stupor, coma, and respiratory arrest), regardless of the degree of hyponatremia

  • Strongly considered for those who have moderate-to-severe hyponatremia with a documented duration of less than 48 hours

The goal is to correct hyponatremia at a rate that does not cause neurologic complications, as follows:

  • Raise serum sodium by 0.5-1 mEq/hr, and not more than 10-12 mEq in the first 24 hours

  • Aim at maximum serum sodium of 125-130 mEq/L


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