Community Minded

Hyponatremia: What is the best approach? 
A 74 year old woman with lung cancer presents with symptomatic hyponatremia with a PNa of 115 meq/l. After initial treatment gets her PNa up to 123, she is fluid restricted and her PNa does not budge. What is the role of urine Na and K and osmolality in this new steady state? What are the pros and cons of fluid restriction, increased osmotic intake with oral urea, and ADH antagonism with tolvaptan? If tolvaptan is used, what should the starting dose be? This is a practical discussion

Summary provided by Roger Rodby, MD, MS.
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