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Fluid restriction is the mainstay for managing patients with nonemergent syndrome of inappropriate antidiuretic hormone (SIADH) secretion. For patients who fail to respond to fluid restriction, potential options include adding furosemide, furosemide plus salt tablets, vaptans, or urea. However, a recent study showed no additional benefit with furosemide plus salt tablets (NEJM JW Gen Med Oct 1 2020 and Am J Kidney Dis 2020; 76:203). To investigate whether a recently introduced, more-palatable urea formulation is safe and effective, researchers performed a meta-analysis of 16 observational studies that involved 518 patients with SIADH.
SIADH severity in these studies ranged from mild to severe. Dosages of urea (via nasogastric tube or orally)…