- Patients with severe symptoms or SAH at risk for vasospasm will receive hypertonic saline; otherwise the cornerstone of treatment for SIADH is fluid restriction.
- Acute hyponatremia and/or severe symptoms should have 6 mmol/L corrected over 6 h or until severe symptoms improve.
- The total correction of Na should not exceed 8 mmol/L over 24 h. Therefore, if 6 mmol/L is corrected in 6 h, the Na should not be increased more than 2 mmol/L in the following 18 h.
- The total correction of Na is based on the Na deficit which is calculated conservatively with the formula depicted.
- With improvement of symptoms, the patients can be moved to the less aggressive treatments in the algorithm, until Na reaches 131 mmol/L.
Layon, A. Joseph, Andrea Gabrielli, and William A Friedman. Textbook Of Neurointensive Care. Print.