Are there instances when you would use urea to treat SIADH in patients with cirrhosis?

In SIADH, the administered urea is subsequently excreted in the urine, resulting in a urea osmotic diuresis. The osmotic diuresis results in the excretion of water in excess of sodium and potassium, thereby leading to an increase in the serum sodium concentration. In contrast, the increased ADH secretion in the setting of cirrhosis is not inappropriate but rather appropriately increased in the setting of decreased effective arterial blood volume due to splanchnic vasodilation. It is well known t...

HypoNa in cirrhosis is the hardest HypoNA to treat IMO. It is hypervolemic hypoNa but diuretics dont usually help enough as they reposed poorly,, often in HRS or risking HRS, Tolvaptan is contraindicated (Black box) (even though I think that is overkill, a few doses won't hurt, the liver issues with tolvaptan were seen in much higher doses used ADPKD and were used for a long time, and in the original SALT trials (NEJM) with tolvaptan and hypoNa, 1/3 of the patients had cirrhosis), urea has the p...