hyponatremia and hemodilution

Urine sodium

<20 mEq/L

>20 mEq/L

Sodium loss in the urine

Other Tests: Blood urea nitrogen, urine specific gravity, radioimmunoassay of ADH


Restoration of normal electrolyte and fluid balance and normal body fluid concentration are the treatment goals. Treatment involves correction of the underlying cause and correction of hyponatremia. If the patient's life is not in danger from airway compromise or severe hyponatremia, the physician often restricts fluids initially to 600 to 800 mL per 24 hours or less. With fluid restriction, the hormone aldosterone is released by the adrenal gland and the patient begins to conserve sodium in the kidneys. As serum sodium increases, SIADH gradually corrects itself. The patient needs assistance to plan fluid intake, and a dietary consultation is also required for consistency in fluid management.

If fluid restriction is unsuccessful, the physician may prescribe an intravenous (IV) infusion of a 3% to 4.5% saline solution. Use caution in administering these hypertonic solutions, and always place them on an infusion control device to regulate the infusion rate precisely. Monitor the patient carefully because sodium and water retention may result, thus leading to pulmonary congestion and shortness of breath.

Diuretics to remove excess fluid volume may be used in patients with cardiac symptoms.

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