Chronic SIADH Pharmacotherapy — ESENeph MCQ

Correct answer: D — Replace the causative medicine and reassess fluid and solute intake

The best answer is “Replace the causative medicine and reassess fluid and solute intake”. The reversible trigger comes first. Persistent cases require specialist selection among increased solute, loop-plus-salt or vasopressin-antagonist strategies under local guidance and sodium monitoring. “Use hypertonic saline for severe symptomatic hyponatraemia with close monitoring” is less appropriate because this is reserved for severe symptomatic scenarios with intensive monitoring “Use desmopressin when excessive water diuresis risks overly rapid correction” is less appropriate because this aggravates SIAD-related hyponatraemia “Use isotonic saline when clinical assessment supports extracellular depletion” is less appropriate because concentrated urine can excrete sodium while retaining water, worsening SIAD “Use tolvaptan after specialist assessment when an approved indication applies” is less appropriate because overcorrection and indication require controlled expert use

Reference: European clinical practice guideline on hyponatraemia: https://academic.oup.com/ejendo/article/170/3/G1/6668028