Fluid restriction is your most important treatment
Drink no more than the amount specified by your doctor
Count all fluids: water, juice, coffee, soup, ice cream
Follow a higher-salt and higher-protein diet if advised
Salt tablets or sodium-rich broth as recommended
Protein goal approximately 1 gram per kg body weight per day
Take all medications exactly as prescribed
If a medication was stopped because it caused low sodium, do not restart it without talking to your doctor
Avoid excessive free water intake
Do not drink large amounts of water at once
Avoid energy drinks or sports drinks with low sodium
Warning signs to return to ER immediately
Confusion or difficulty speaking
Difficulty walking or new unsteadiness
Severe headache
Seizure or shaking episode
Persistent vomiting preventing fluid restriction
Extreme drowsiness or difficulty staying awake
If a family member notices you are unusually confused
Follow-up plan
Blood sodium recheck within 1-3 days of discharge
Earlier if symptoms change
Your doctor will tell you when and where
Clinic or specialist follow-up as arranged
Nephrology, endocrinology, or internal medicine
If on new medications for sodium, do not stop without calling your doctor
Lifestyle guidance
Fluid restriction tips: measure your fluid containers
Use a marked water bottle to track daily intake
Spread fluid allowance throughout the day
If you feel thirsty despite restriction
Sucking on ice chips counts as fluid but uses less volume
Chew gum to reduce dry mouth sensation
References
Guidelines and key sources
Primary references
Adrogué HJ, Madias NE. The Syndrome of Inappropriate Antidiuresis. NEJM 2023
Comprehensive management algorithm and correction rate evidence
NEJM doi/10.1056/NEJMcp2210411
Adrogué HJ, Tucker BM, Madias NE. Diagnosis and Management of Hyponatremia: A Review. JAMA 2022
Differential diagnosis framework and diagnostic criteria
JAMA doi/10.1001/jama.2022.11176
Warren AM, Grossmann M, Christ-Crain M, Russell N. Syndrome of Inappropriate Antidiuresis: From Pathophysiology to Management. Endocrine Reviews 2023
ODS risk stratification and management evidence
PubMed 36974717
Supporting evidence
Beck J. Treatment of Chronic Hyponatremia and Controversy About Osmotic Demyelination Syndrome. Best Pract Res Clin Endocrinol Metab 2025
ODS controversy and treatment thresholds
PubMed 41219109
Refardt J, Winzeler B, Christ-Crain M. Copeptin and its role in the diagnosis of diabetes insipidus and the syndrome of inappropriate antidiuresis. Clin Endocrinol 2019
Copeptin as AVP surrogate in diagnosis
Wiley doi/10.1111/cen.13991
Miller NE, Rushlow D, Stacey SK. Diagnosis and Management of Sodium Disorders. Am Fam Physician 2023
Primary care perspective on hyponatremia management
PubMed 37983699
Coding standards
ICD-10 E22.2: syndrome of inappropriate antidiuretic hormone secretion
ICD-10 E87.1: hyponatremia
SNOMED CT: syndrome of inappropriate antidiuretic hormone secretion disorder concept
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.