How to manage<unk>  depends on whether symptoms are present, the severity of the hyponatremia, and the duration. Management of<unk>  includes: * Removing the underlying cause when possible. * Mild and asymptomatic hyponatremia is treated with adequate solute intake (including salt and protein) and fluid restriction starting at 500 ml per day of water with adjustments based on serum sodium levels. Long-term fluid restriction of 1,200–1,800 mL/day may maintain the person in a symptom free state. * Moderate and symptomatic hyponatremia is treated by raising the serum sodium level by 0.5 to 1 mmol per liter per hour for a total of 8 mmol per liter during the first day with the use of furosemide and replacing sodium and potassium losses with 0.9% saline. * For people with severe symptoms (severe confusion, convulsions, or coma) hypertonic saline (3%) 1–2 ml/kg IV in 3–4 h should be given. * Drugs * Demeclocycline can be used in chronic situations when fluid restrictions are difficult to maintain; demeclocycline is the most potent inhibitor of Vasopressin (ADH/AVP) action. However, demeclocycline has a 2–3 day delay in onset with extensive side effect profile, including skin photosensitivity, and nephrotoxicity. * Urea: oral daily ingestion has shown favorable long-term results with protective effects in myelinosis and brain damage. Limitations noted to be undesirable taste and is contraindicated in people with cirrhosis to avoid initiation or potentiation of hepatic encephalopathy. * Conivaptan – an antagonist of both V1A and V2 vasopressin receptors. * Tolvaptan – an antagonist of the V2 vasopressin receptor. Raising the serum sodium concentration too rapidly may cause central pontine myelinolysis. Avoid correction by more than 12 mEq/L/day. Initial treatment with hypertonic saline may abruptly lead to a rapid dilute diuresis and fall in ADH.
Syndrome of inappropriate antidiuretic hormone secretion
Central diabetes insipidus
Nephrogenic diabetes insipidus
Apparent mineralocorticoid excess syndrome
Primary polydipsia
Adrenal crisis
Cerebral salt-wasting syndrome
Exercise-associated hyponatremia