Adult Hyponatremia Evaluation, Management, and Safe Correction

Authored by Sourabh Sharma, published on 2026-11-12 12:24:30.0

Confirmed Hypotonic Hyponatremia: Severe Neurological Symptoms?
- Give 3% Hypertonic Saline in Monitored Setting
  - Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
    - Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
      - Continue Cause-Directed Therapy and Arrange Follow-Up
      - Reassess Clinical Status and Diagnosis; Escalate to Nephrology
      - Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
  - Urine Osmolality ≤100 mOsm/kg?
    - Restrict Free Water and Restore Solute Intake
      - Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
    - Urine Sodium ≤30 mmol/L?
      - Determine Low Effective Volume Phenotype
        
        Treat Gastrointestinal or Third-Space Losses With Isotonic Saline
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Restrict Fluid; Use Loop Diuretics and Optimize Heart Failure
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Treat Cirrhosis; Restrict Fluid and Adjust Diuretics as Indicated
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Reassess Diuretics, CKD, Intake, and Volume Status
        
        Assess Volume, Diuretics, CKD, Cortisol, and TSH
        
        Classify Clinical Volume Phenotype
        
        Identify Hypovolemic Renal Cause
        
        Stop Offending Diuretic and Restore Volume With Saline
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Replace Salt and Treat Renal Salt Loss
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Start Glucocorticoid Replacement and Volume Support
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Identify Euvolemic Hyponatremia Cause
        
        Restrict Fluid; Add Solute, Urea, or Selected Vaptan if Persistent
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Start Glucocorticoid Replacement and Volume Support
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Treat Clinically Significant Hypothyroidism With Thyroid Hormone
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Identify Hypervolemic Hyponatremia Cause
        
        Restrict Fluid; Use Loop Diuretics or Dialysis for CKD
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Restrict Fluid; Use Loop Diuretics and Optimize Heart Failure
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Treat Cirrhosis; Restrict Fluid and Adjust Diuretics as Indicated
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
      - Assess Volume, Diuretics, CKD, Cortisol, and TSH
        
        Classify Clinical Volume Phenotype
        
        Identify Hypovolemic Renal Cause
        
        Stop Offending Diuretic and Restore Volume With Saline
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Replace Salt and Treat Renal Salt Loss
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Start Glucocorticoid Replacement and Volume Support
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Identify Euvolemic Hyponatremia Cause
        
        Restrict Fluid; Add Solute, Urea, or Selected Vaptan if Persistent
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Start Glucocorticoid Replacement and Volume Support
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Treat Clinically Significant Hypothyroidism With Thyroid Hormone
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Identify Hypervolemic Hyponatremia Cause
        
        Restrict Fluid; Use Loop Diuretics or Dialysis for CKD
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Restrict Fluid; Use Loop Diuretics and Optimize Heart Failure
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Treat Cirrhosis; Restrict Fluid and Adjust Diuretics as Indicated
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
- Urine Osmolality ≤100 mOsm/kg?
  - Restrict Free Water and Restore Solute Intake
    - Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
      - Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
  - Urine Sodium ≤30 mmol/L?
    - Determine Low Effective Volume Phenotype
      - Treat Gastrointestinal or Third-Space Losses With Isotonic Saline
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
      - Restrict Fluid; Use Loop Diuretics and Optimize Heart Failure
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
      - Treat Cirrhosis; Restrict Fluid and Adjust Diuretics as Indicated
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
      - Reassess Diuretics, CKD, Intake, and Volume Status
        
        Assess Volume, Diuretics, CKD, Cortisol, and TSH
        
        Classify Clinical Volume Phenotype
        
        Identify Hypovolemic Renal Cause
        
        Stop Offending Diuretic and Restore Volume With Saline
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Replace Salt and Treat Renal Salt Loss
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Start Glucocorticoid Replacement and Volume Support
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Identify Euvolemic Hyponatremia Cause
        
        Restrict Fluid; Add Solute, Urea, or Selected Vaptan if Persistent
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Start Glucocorticoid Replacement and Volume Support
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Treat Clinically Significant Hypothyroidism With Thyroid Hormone
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Identify Hypervolemic Hyponatremia Cause
        
        Restrict Fluid; Use Loop Diuretics or Dialysis for CKD
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Restrict Fluid; Use Loop Diuretics and Optimize Heart Failure
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Treat Cirrhosis; Restrict Fluid and Adjust Diuretics as Indicated
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
    - Assess Volume, Diuretics, CKD, Cortisol, and TSH
      - Classify Clinical Volume Phenotype
        
        Identify Hypovolemic Renal Cause
        
        Stop Offending Diuretic and Restore Volume With Saline
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Replace Salt and Treat Renal Salt Loss
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Start Glucocorticoid Replacement and Volume Support
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Identify Euvolemic Hyponatremia Cause
        
        Restrict Fluid; Add Solute, Urea, or Selected Vaptan if Persistent
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Start Glucocorticoid Replacement and Volume Support
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Treat Clinically Significant Hypothyroidism With Thyroid Hormone
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Identify Hypervolemic Hyponatremia Cause
        
        Restrict Fluid; Use Loop Diuretics or Dialysis for CKD
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Restrict Fluid; Use Loop Diuretics and Optimize Heart Failure
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Treat Cirrhosis; Restrict Fluid and Adjust Diuretics as Indicated
        
        Set ODS-Adjusted Limits; Monitor Sodium and Urine Output
        
        Brisk Aquaresis or Overcorrection? If No, Is Response Adequate?
        
        Continue Cause-Directed Therapy and Arrange Follow-Up
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology
        
        Stop Correction; Give Desmopressin and Hypotonic Fluid
        
        Reassess Clinical Status and Diagnosis; Escalate to Nephrology

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