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  1. Standard first line therapy is water restriction.
  2. If more rapid correction of hyponatremia is desired, the fluid restriction can be supplemented with i. v. infusion of hypertonic saline (3%).
Important Points
  1. A rapid correction will produce central pontine myelinolysis which is an acute potentially fatal neurological syndrome characterized by quadriparesis, ataxia and abnormal extraocular movements.
  2. To prevent this complication the hypertonic saline should be infused slowly.

Treatment of Chronic SIADH

  1. Hyponatremia can be corrected by with
    1. Demeclocycline
    2. Conivaptan

Recent Advances Conivaptan is a new drug. It is a treatment option for hyponatremia in place of Demeclocycline. (Ref. Hari. 18th ed., Pg - 349, 828).



Certain conditions that interfere with laboratory tests of serum sodium concentration (may lead to an erroneously low measurement of sodium. This is called pseudohyponatremia).

  1. Hyperlipidemia
  2. Hyper paraproteinemia (Multiple myeloma)
  3. Severe hyperglycemia (DKA, NKHOC)


  1. It is a non-peptide inhibitor of antidiuretic hormone (vasopressin receptor antagonist).
  2. It is for hyponatremia (low blood sodium levels) caused by syndrome of inappropriate antidiuretic hormone (SIADH)
  3. Conivaptan inhibits two of the three subtypes of the vasopressin receptor (V1a and V2).
  4. Effectively, it causes iatrogenic nephrogenic diabetes insipidus.

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