Treatment of SIADH

(NEJM 2007;356:2064; AJKD 2020;76:203): fluid restrict + treat underlying cause

hypertonic saline (± loop diuretic; AJKD 2020;76:203) if sx or Na fails to ↑ w/ fluid restriction Intermittent bolus of 3% saline (~2 mL/kg q6h) vs. continuous infusion (~0.5 mL/kg/h) similar (JAMA IM 2021;181:81) when moderate symptoms. Must recheck serum Na frequently during hypertonic use (at least q2h).

NaCl tabs if chronic and no CHF. Consider urea 0.25–0.5 g/kg/d (CJASN 2018;13:1627)

aquaresis: vaptans (vasopressin receptor antag) for refractory SIADH (NEJM 2015;372:23)