title: Treatment of hyponatremia induced by the syndrome of Inappropriate antidiuretic hormone secretion: a multidisciplinary spanish algorithm.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.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: D000465:Algorithms; D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use; D001552:Benzazepines / Q000627:therapeutic use; D006801:Humans; D007010:Hyponatremia / Q000209:etiology* / Q000628:therapy*; D007177:Inappropriate ADH Syndrome / Q000150:complications*; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D012462:Saline Solution, Hypertonic; D000077602:Tolvaptan