How are hyponatremia patterns managed?

• A. Fluids restricted across the board; no nuance.
• B. Fluid restriction for SIADH or cautious saline/vasopressin for salt wasting; monitor osmolality.
• C. Immediate hypertonic saline for all hyponatremia.
• D. No specific management beyond treating cause.

Answer: (B)

Hyponatremia management hinges on identifying the pattern of water and salt balance. In SIADH, there is dilutional hyponatremia from excess water retention, so the main approach is fluid restriction to reduce free water intake and let sodium rise gradually, with careful monitoring of serum osmolality and sodium to avoid overshoot. In salt-wasting patterns (where there is actual sodium loss with volume depletion), restoring volume with saline helps correct both the fluid deficit and the sodium level; this is done cautiously, with ongoing osmolality monitoring to prevent too-rapid correction. The key is tailoring therapy to the underlying pattern and watching the osmolar trajectory so adjustments can be made as needed.