What are the treatment guidelines for syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

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

European guidelines for the treatment of syndrome of inappropriate antidiuresis include the following recommendations for management of moderate or profound hyponatremia [30] :

  • Restrict fluid intake as first-line treatment
  • Second-line treatments include increasing solute intake with 0.25–0.50 g/kg per day of urea or a combination of low-dose loop diuretics and oral sodium chloride
  • Use of lithium, demeclocycline, or vasopressin receptor antagonists is not recommended

Recommendations on the treatment of SIADH from an American Expert Panel included the following [31] :

  • If chronic, limit rate of correction
  • Fluid restriction should generally be first-line therapy
  • Consider pharmacologic therapies if serum Na + is not corrected after 24-48 hr of fluid restriction or if patient has a low urinary electrolye free water excretion
  • Patients being treated with vaptans should not be on a fluid restriction initially
  • Water, 5% dextrose or desmopressin can be used to slow the rate of correction if the water diuresis is profound

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