From the Guidelines
Salt tablets are not recommended for treating hyponatremia (sodium level of 128) caused by SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion). In SIADH, the body retains too much water relative to sodium, diluting the sodium concentration in the blood. Taking salt tablets would not effectively address this underlying problem because the excess water would still dilute the additional sodium.
Treatment Approach
The primary treatment for SIADH involves:
- Fluid restriction (typically limiting intake to 800-1000 mL per day) to allow the body to eliminate excess water and naturally increase sodium concentration 1.
- For more severe or persistent cases, medications like tolvaptan or demeclocycline may be prescribed to increase water excretion by the kidneys 1.
Key Considerations
- Loop diuretics combined with salt tablets might be used in specific hospital settings under close monitoring, but this is not a standard outpatient approach.
- The treatment should address the underlying cause of SIADH, which could include medications, lung disorders, central nervous system disorders, or certain cancers.
- If symptoms like confusion, seizures, or severe weakness are present, immediate medical attention is necessary as severe hyponatremia can be dangerous.
Evidence-Based Recommendation
The most recent and highest quality study 1 supports the use of fluid restriction and medications like demeclocycline and vasopressin receptor inhibitors for the treatment of SIADH, rather than salt tablets. This approach prioritizes the patient's morbidity, mortality, and quality of life by addressing the underlying cause of the condition and managing its symptoms effectively.
From the Research
Treatment of Hyponatremia due to SIADH
The treatment of hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) depends on the severity of the condition and the presence of symptoms.
- For acute correction of hyponatremia posing as a medical emergency, the mainstay of treatment is the intravenous use of 3% hypertonic saline solution 2, 3.
- For mild or moderate, non-acute hyponatremia, treatment options include fluid restriction, solute, furosemide, and tolvaptan to achieve eunatremia in patients with SIADH 2, 3.
- Vasopressin receptor antagonists, called vaptans, have been introduced as specific and direct therapy of SIADH, and appear advantageous to patients because there is no need for fluid restriction and the correction of hyponatremia can be achieved comfortably and within a short time 4.
- Urea has also been used as a treatment for SIADH-induced hyponatremia, and has been shown to be effective and well-tolerated in patients with subarachnoid hemorrhage 5.
Use of Salt Tablets
There is no mention of salt tablets as a treatment option for hyponatremia due to SIADH in the provided studies.
- The studies suggest that salt administration, in the form of hypertonic saline solution, can be used to correct hyponatremia in SIADH, but this is typically done intravenously and in a controlled manner 2, 3, 6.
- The use of salt tablets is not a recommended treatment option for hyponatremia due to SIADH, and may not be effective in correcting the condition.
Important Considerations
It is important to limit the daily increase of serum sodium to less than 8-10 mmol/liter to avoid osmotic demyelination 4.
- The rate of correction of hyponatremia depends on the degree of hyponatremia and the presence or absence of symptoms, and excessively rapid correction should be avoided 6.