How to Treat SIADH Without Making It Worse

Your patient has confirmed SIADH. Now what? This episode is all protocol — four clinical scenarios that cover every treatment situation you'll encounter, from the emergency department to the ICU to the outpatient clinic.We start with acute symptomatic hyponatremia: why the answer is a 100–150 mL bolus of 3% saline, not an infusion, and why normal saline can paradoxically worsen things through desalination. Then the scenario that keeps nephrologists up at night — the high-risk patient primed for overcorrection, where the proactive desmopressin clamp removes the variable you can't control. We cover what to do when overcorrection has already happened (act on the numbers, not the exam — osmotic demyelination doesn't show for days). Then subarachnoid hemorrhage, where fluid restriction is contraindicated and the standard rules don't apply. And finally, the outpatient patient with chronic SIADH who can't tolerate fluid restriction — why oral urea beats tolvaptan and salt tablets in most cases.Every scenario ends with a clear rule. The treatment algorithm at the close ties it all together.Next episode: salt wasting syndromes — the conditions that look exactly like SIADH on labs but require the opposite treatment.