Ensuring that serum osmolality increases and urine osmolality decreases allows the provider to confirm that the patient is losing serum volume into the urine.
Daily weights are the staple for monitoring fluid level in any patient. Carefully monitoring intake and output in these patients is also advised to prevent fluid overload.
There are not many instances where we restrict fluid intake in patients. SIADH patients are placed on a fluid restriction of 1L/day to promote an increase of serum osmolality. Severe cases may be restricted to 500mL/day.
Excess fluid volume in these patients causes shifts of electrolytes, especially sodium. Careful monitoring of these patient’s CNS function and cardiac status is imperative as these may deteriorate quickly.
Patients with dilutional hyponatremia are at an increased risk for seizures and should be placed on seizure precautions to ensure safety as low sodium levels often precipitate seizures.
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