DISTINGUISHING FEATURES OF APPROPRIATELY VERSUS INAPPROPRIATELY INCREASED ADH

CONCENTRATIONS
The serum BUN and creatinine levels are normal, and the serum uric acid level is generally reduced.
The urinary sodium concentration is usually greater than 30 mEq/L, and the fractional excretion of
sodium is greater than 1%.
Tests of adrenal function yield normal results
A useful diagnostic and therapeutic maneuver in this situation is to observe the results of water restriction.
When water intake is restricted to 600 to 800 mL/d, patients with SIADH exhibit a highly characteristic
response: a 2- to 3-kg weight loss is accompanied by correction of hyponatremia and cessation of salt
wasting, usually over 2 to 3 days.
If weight loss fails to correct both hyponatremia and urinary sodium wasting simultaneously, the diagnosis
of SIADH is doubtful.