From the Research
Oral furosemide and salt tablets are not the preferred treatment for Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), and their use should be limited to patients who cannot tolerate fluid restriction or other therapies. The primary management of SIADH should focus on fluid restriction (typically 800-1000 mL/day) and addressing the underlying cause. For pharmacological management, oral urea (30-60 g/day) or vasopressin receptor antagonists like tolvaptan (starting at 15 mg daily) are preferred options, as they have been shown to be effective in correcting hyponatremia with a lower risk of complications 1. Furosemide (20-40 mg orally once or twice daily) may be used as an adjunctive therapy in some cases to enhance free water excretion, but it must be combined with sodium chloride supplementation (typically 1-2 g three times daily) to prevent further hyponatremia, as evidenced by a study that found no significant benefit of furosemide with sodium chloride supplementation compared to fluid restriction alone 2. However, this approach can cause electrolyte imbalances and is generally less effective than other treatments. It should only be considered in patients who cannot tolerate fluid restriction or other therapies, and requires close monitoring of serum sodium levels, with a target correction rate not exceeding 8 mEq/L in 24 hours to avoid osmotic demyelination syndrome. Some key points to consider when managing SIADH include:
- The importance of fluid restriction as the primary treatment
- The use of oral urea or vasopressin receptor antagonists as preferred pharmacological options
- The potential risks and limitations of using furosemide and salt tablets
- The need for close monitoring of serum sodium levels to avoid complications. Overall, the management of SIADH should prioritize fluid restriction and the use of oral urea or vasopressin receptor antagonists, with furosemide and salt tablets reserved for specific cases where other treatments are not tolerated or effective.