Management Options For Chronic Asymptomatic Hyponatremia

Treatment

Mechanism of Action

Dose

Advantages

Limitations

Fluid restriction

Decreases availability of free water

Variable

Effective and inexpensive

Noncompliance

Pharmacologic inhibition of antidiuretic hormone action Lithium

Demeclocycline V2-receptor antagonist

Inhibits the kidney's response to antidiuretic hormone Inhibits the kidney's response to antidiurectic hormone Antagonizes vasopressin action

900-1200 mg/d

1200 mg/d initially; then, 300-900 mg/d

Unrestricted water intake

Effective; unrestricted water intake Ongoing trials

Polyuria, narrow therapeutic range, neurotoxicity Neurotoxicity, polyuria, photo-sensitivity, nephrotoxicity

Increased solute intake Furosemide

Urea

Increases free water clearance Osmotic diuresis

Titrate to optimal dose; coadminister 2-3 g sodium chloride 30-60 g/d

Effective

Effective; unrestricted water intake

Ototoxicity, K+ and Mg2+ depletion

Polyuria, unpalatable gastrointestinal symptoms

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