Management of SIADH Treat underlying cause: • Causes can include pain, primary lung pathology, post-operative phenomenon, medications, etc. Free water restriction: • Restrict 1 to 1.5L per day • Can be difficult for patients to maintain long-term Salt tablets: • Start with 1g NaCl PO TID • With lower Na, increase the number and frequency of salt tablets administered • Can cause volume overload Urea powder: • 15-30g PO daily • 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 0.9% Normal Saline: • If Urine osmolality < 538 AND UNa + UK < 154, can try giving a 250cc bolus of 0.9% NS Vasopressor receptor antagonists: • Blocks ADH receptor • Has many side effects Satya Patel, MD @SatyaPatelMD #SIADH #Management #hyponatremia #nephrology #treatment
