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Edgar V. Lerma and Helbert Rondon-Berrios

The conventional first-line therapy for any patient presenting with hypotonic hyponatremia due to SIAD (syndrome of inappropriate antidiuresis) is that of fluid restriction. However, we recognize that fluid restriction alone does not always work. The Expert Panel Recommendations on Diagnosis, Evaluation, and Treatment of Hyponatremia, published in 2013, identified certain criteria that are predictive of which patients are less likely to respond to fluid restriction alone (1). These include a urine-to-plasma electrolyte ratio ([urine Na + urine K]/plasma sodium [PNa]) >1 or a high urine osmolality (>500 mOsm/kg H2O).

It has been suggested that those patients