In SIADH presenting with moderately severe symptoms, the first treatment step targets a defined rise in serum sodium. When that target is not met and symptoms persist, a specific next-line protocol applies.
The initial protocol — which included stopping medications contributing to hyponatraemia, cause-specific treatment, and a single i.v. infusion of hypertonic saline — did not achieve the goal of a 5 mmol/l per 24-hour increase in serum sodium concentration with improvement of symptoms.
Hyponatraemia with moderately severe symptoms is a dangerous condition. This protocol addresses the situation where those symptoms remain unresolved and the sodium correction threshold was not reached with the initial single-infusion approach.
Management escalates to the approach used in severely symptomatic hyponatraemia, involving repeated i.v. hypertonic saline infusions in a setting that allows close biochemical and clinical monitoring — the full repetition criteria, monitoring schedule, and stopping rules are contained in the complete protocol.
A 5 mmol/l increase in serum sodium concentration with improvement of symptoms.
DOI: 10.1530/EJE-13-1020
Hyponatraemia with moderately severe symptoms is a dangerous condition.
We suggest considering to manage the patient as in severely symptomatic hyponatraemia if the serum sodium concentration further decreases despite treating the underlying diagnosis (2D).
We suggest repeating therapeutic recommendations 7.1.1.1 and 7.1.1.2 twice or until a target of 5 mmol/l increase in serum sodium concentration is achieved (2D).
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