title: [The treament of hyponatremia secundary to the syndrome of inappropriate antidiuretic hormone secretion].
abstract: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most frequent cause of hyponatremia in a hospital setting. However, detailed protocols and algorithms for its management are lacking. Our objective was to develop 2 consensus algorithms for the therapy of hyponatremia due to SIADH in hospitalized patients. A multidisciplinary group made up of 2 endocrinologists, 2 nephrologists, 2 internists, and one hospital pharmacist held meetings over the period of a year. The group worked under the auspices of the European Hyponatremia Network and the corresponding Spanish medical societies. Therapeutic proposals were based on widely-accepted recommendations, expert opinion and consensus guidelines, as well as on the authors' personal experience. Two algorithms were developed. Algorithm 1 addresses acute correction of hyponatremia posing as a medical emergency, and is applicable to both severe euvolemic and hypovolemic hyponatremia. The mainstay of this algorithm is the iv use of 3% hypertonic saline solution. Specific infusion rates are proposed, as are steps to avoid or reverse overcorrection of serum sodium levels. Algorithm 2 is directed to the therapy of SIADH-induced mild or moderate, non-acute hyponatremia. It addresses when and how to use fluid restriction, solute, furosemide, and tolvaptan to achieve eunatremia in patients with SIADH. Two complementary strategies were elaborated to treat SIADH-induced hyponatremia in an attempt to increase awareness of its importance, simplify its therapy, and improve prognosis.
authors.affiliation: Servicio de Endocrinología, Hospital Universitario Clínico San Carlos, Madrid, España. Electronic address: isabelle.runkle@salud.madrid.org.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Runkle
authors.forename: Carles
authors.initials: C
authors.lastname: Villabona
authors.forename: Andrés
authors.initials: A
authors.lastname: Navarro
authors.forename: Antonio
authors.initials: A
authors.lastname: Pose
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.forename: Alberto
authors.initials: A
authors.lastname: Tejedor
authors.forename: Esteban
authors.initials: E
authors.lastname: Poch
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D001552:Benzazepines / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003661:Decision Support Techniques; D005440:Fluid Therapy / Q000379:methods; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D007010:Hyponatremia / Q000209:etiology / Q000628:therapy*; D007177:Inappropriate ADH Syndrome / Q000150:complications*; D007262:Infusions, Intravenous; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D012720:Severity of Illness Index; D000077602:Tolvaptan
chemical_list: D001552:Benzazepines; D012462:Saline Solution, Hypertonic; D000077602:Tolvaptan; D005665:Furosemide
keywords: Algorithm; Algoritmo; Consenso; Consensus; Encefalopatía hiponatrémica; Hiponatremia; Hipoosmolalidad plasmática; Hyponatremia; Hyponatremic encephalopathy; Plasma hyposmolality; Syndrome of inappropriate antidiuretic hormone secretion; Síndrome de secreción inadecuada de vasopresina; Tolvaptan; Tolvaptán