How to manage moderate SIAD?

Ally Prebtani, MD, is an endocrinologist, internist, and professor of medicine at McMaster University. He has developed clinical practice guidelines as part of Diabetes Canada and Hypertension Canada. He is actively involved in teaching, advocacy work, clinical work, and research.

What management is recommended in moderate syndrome of inappropriate diuresis (SIAD)?

Ally Prebtani, MD: They are patients who are symptomatic but not severely symptomatic, especially if they’re chronic. Then, you probably don’t want to use 3% normal saline because you don’t want to correct them too quickly. Then, you would think of things like water restriction or food restriction, sodium tablets or sodium, and also sometimes urea can help. It’s very effective compared to water restriction and compared to sodium tablets, but it doesn’t taste very good. But you can mix it with fruit juice or sirup to make it more palatable.

So, those are the 3 most important things, but always look for the reason. And also, another therapy we use is a loop diuretic such as furosemide. That also can be done. Those are sort of the mainstays of the approach to moderate hyponatremia, which is not very, very acute.