How is acute syndrome of inappropriate antidiuretic hormone secretion (SIADH) treated?

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 the acute setting (ie, < 48 h since onset) with moderate symptoms such as confusion, delirium, disorientation, nausea, and vomiting, the treatment options for the hyponatremia include 3% hypertonic saline (513 mEq/L), loop diuretics with saline, vasopressin-2 receptor antagonists (aquaretics), and water restriction.

Depending on the rate of development of hyponatremia, the approach to correction varies. If an acute onset and moderate neurologic symptoms have occurred, the use of hypertonic saline may be warranted (discussed under Emergent Care). If symptoms are less severe (headache, irritability, inability to concentrate, altered mood) or absent, then vasopressin-2 receptor antagonists (aquaretics) or water restriction are both options. The patient's serum Na+ level and clinical status must be monitored often to determine the need for continued aggressive therapy.


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