What factors influence your decision to start salt tablets, urea, or a vaptan first in the management of a patient diagnosed with SIADH?  

In patients with SIADH, free water intake has to be less than the urinary electrolyte-free water clearance in order for the serum sodium level to increase, assuming no significant extra-renal fluid losses. Therefore, if urinary electrolyte-free water clearance is very low, then free fluid restrictio...

I have used vaptans as an initial therapy in selected patients. For example, for patients with post-operative mediated SIADH. In these cases, there is a push for the patient to leave the hospital to continue rehab. In most cases, the post-operative ADH-mediated hyponatremia is self-limiting, but by ...

One seldom needs vaptan as an initial treatment, as alluded to in the framed question. All the interventions mentioned above generally suffice to stabilize serum osmolality. Refractory or persistent hyponatremia may require vaptan therapy. However, a shout-out to the old, trusted, and reliable stan...