SIADH Treatment Options 1. Treat underlying cause of SIADH: Pain, Primary lung pathology, Post-operative phenomenon, Medications, Basically anything 2. Free water restriction • All food has water • Electrolyte Free Water Clearance (EFWC) Equation • For practical purposes, restrict to 1 to 1.5L per day (if you plan on using this as a long-term solution, you should prove feasibility during hospitalization) 3. Salt tabs • Start with lg NaCl PO TID • With lower Na, you should increase the number and frequency of salt tablets administered • This can cause volume overload 4. Urea powder • Induces osmotic water elimination by promoting passive sodium reabsorption in the ascending limb of the loop of Henle • Contraindicated in cirrhosis given the potential for it to be metabolized into ammonium by urease-producing bacteria in the colon 5. 0.9% NS • If Urine osmolality < 538 AND UNa + UK < 154, can try giving 0.9% NS • Give 250 cc NS boluses at a time • Re-check the serum Na+ in 2-4 hours and decide before giving more 6. Vasopressor receptor antagonists (-vaptans) • Blocks ADH receptor • Major side effects: Thirst, Nausea, Hypotension, Increased urine output Satya Patel, MD @SatyaPatelMD #SIADH #Management #hyponatremia #nephrology #treatment
