Syndrome of inappropriate secretion of antidiuretic hormone and hyponatremia

Abstract

1. On the basis of strong research evidence (level A), administration of isotonic fluid is recommended as the first choice for intravenous (IV) fluid in hospitalized children. (10)(15)(16)(35)(36)(37) 2. On the basis of primarily consensus, due to lack of relevant clinical studies (level D), careful monitoring of serum electrolyte levels is required after initiation of IV fluids to avoid hyponatremia. (4)(41) Evaluation of children with hyponatremia is aimed at determining the underlying cause so that treatment can be appropriately outlined. 3. On the basis of strong research evidence (level B), symptomatic hyponatremia deserves immediate treatment with hypertonic saline, but thereafter, hyponatremia should be corrected slowly to avoid further central nervous system sequelae. (2)(4)(7)(8)(42) 4. On the basis of some research evidence, as well as consensus (level C), syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a common underlying cause of hyponatremia in children, and most cases are acute and transient conditions. (9)(11)(14)(33)(34) 5. In cases of chronic hyponatremia due to SIADH, treatment options, in addition to fluid restriction, include furosemide, urea, and tolvaptan; treatment recommendations are largely based on some research evidence, as well as consensus (level C). (8)(17)(22)(23)(24)(25)(26)(27)(28) 6. More information will be needed to guide specific recommendations regarding the ideal choice of therapy for children with chronic hyponatremia.