Table 3.

Treatment options for hyponatremia.

Treatment	Indication	Special Considerations in Older People
Optimize prescribing	Drug-induced hyponatremia	Medications more likely to be needed due to co-morbidities.
Isotonic saline	Hypovolemic hyponatremia	Hypovolemia common due to immobility, confusion and malnutrition. Assessment of volemic state is notoriously difficult so may worsen hyponatremia if underlying causes are misdiagnosed.
Hypertonic saline	Severe hyponatremia from any cause	Needs expert monitoring. High potential for over-correction.
Fluid restriction	SIADH	Poor tolerability and high failure rate. Will worsen hyponatremia where dehydration is misdiagnosed as SIADH.
Demeclocycline	SIADH	Unpredictability of effect requires special caution due to lower resilience.
Diuretics	Hypervolemic hyponatremia	Can worsen hyponatremia by increasing urinary sodium excretion.
Salt tablets	Hypovolemic hyponatremia	Rarely indicated as dietary sodium intake is usually sufficient and total body sodium is not normally low in most cases of hyponatremia.
Lithium	SIADH	Inconsistent results, with high risk of adverse drug effects and toxicity.
Urea	SIADH	Only available in some countries. Unpalatable. Higher risk of uremia.
Vaptans	SIADH or hypervolemia	Risk of dehydration and over-correction. Expensive. Only licensed for SIADH in Europe.