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Medication

Medication Summary

Medical therapy in hyponatremia includes the administration of 3% Na chloride (Na, 513 mEq/L), normal Na chloride solution (Na, 154 mEq/L), diuretics, and other drugs used to treat syndrome of inappropriate antidiuretic hormone secretion (SIADH), such as lithium carbonate, demeclocycline, ethanol, phenytoin, and vasopressin analogs.^[18]

Class Summary

These agents promote renal excretion of water and electrolytes. They are used to treat heart failure or hepatic, renal, or pulmonary disease when Na and water retention results in edema or ascites.

Furosemide (Lasix)

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Potent loop diuretic. Inhibits reabsorption of sodium and chloride in proximal and distal tubules and loop of Henle. High efficacy largely due to unique site of action. Action on distal tubule independent of any possible inhibitory effect on carbonic anhydrase or aldosterone.

Class Summary

These agents produce diuresis by inhibiting antidiuretic hormone (ADH)-induced water reabsorption. Rarely used to treat pediatric hyponatremia in the pediatric ICU setting.

Lithium (Eskalith, Lithobid)

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Inhibits renal response to ADH.

Demeclocycline (Declomycin)

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Only tetracycline used to treat SIADH. Produces diuresis by inhibiting ADH-induced water reabsorption in distal portion of convoluted tubules and collecting ducts of kidneys. Effects observed within 5 d and are reversed 2-6 d after cessation of therapy. Administer 1 h before or 2-3 h after ingestion of milk or food.

Phenytoin (Dilantin)

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Inhibits secretion of ADH.

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Pediatric Hyponatremia. Drugs that impair water excretion.

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Author

Muthukumar Vellaichamy, MD, FAAP Clinical Assistant Professor, Department of Pediatrics, Wesley Medical Center, University of Kansas School of Medicine-Wichita

Muthukumar Vellaichamy, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Barry J Evans, MD Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

G Patricia Cantwell, MD, FCCM Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami Leonard M Miller School of Medicine/ Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Director, Palliative Care Team, Holtz Children's Hospital; Medical Manager, FEMA, South Florida Urban Search and Rescue, Task Force 2

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

The author would like to acknowledge his partner at work, mentor, and great physician Lindall Smith, MD, for reading the manuscript and offering valuable advice.

Pediatric Hyponatremia Medication

Medication Summary

Diuretics

Class Summary

Furosemide (Lasix)

Furosemide (Lasix)

ADH inhibitors

Class Summary

Lithium (Eskalith, Lithobid)

Lithium (Eskalith, Lithobid)

Demeclocycline (Declomycin)

Demeclocycline (Declomycin)

Phenytoin (Dilantin)

Phenytoin (Dilantin)

Pediatric Hyponatremia Medication

Medication Summary

Diuretics

Class Summary

Furosemide (Lasix)

Furosemide (Lasix)

ADH inhibitors

Class Summary

Lithium (Eskalith, Lithobid)

Lithium (Eskalith, Lithobid)

Demeclocycline (Declomycin)

Demeclocycline (Declomycin)

Phenytoin (Dilantin)

Phenytoin (Dilantin)

References

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