Treatment of hyponatremia induced by the syndrome of Inappropriate antidiuretic hormone secretion: a multidisciplinary spanish algorithm

Nefrologia. 2014;34(4):439-50. doi: 10.3265/Nefrologia.pre2014.Apr.12220.
[Article in English, Spanish]


Introduction: 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.

Material and 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.

Publication types

  • Consensus Development Conference

MeSH terms

  • Algorithms*
  • Antidiuretic Hormone Receptor Antagonists / therapeutic use
  • Benzazepines / therapeutic use
  • Humans
  • Hyponatremia / etiology*
  • Hyponatremia / therapy*
  • Inappropriate ADH Syndrome / complications*
  • Saline Solution, Hypertonic / therapeutic use
  • Tolvaptan


  • Antidiuretic Hormone Receptor Antagonists
  • Benzazepines
  • Saline Solution, Hypertonic
  • Tolvaptan