Long-term Empagliflozin Use in Chronic Syndrome of Inappropriate Antidiuresis Due to Traumatic Subarachnoid Hemorrhage

Syndrome of inappropriate antidiuresis (SIAD), the leading cause of hyponatremia, poses treatment challenges. Fluid restriction often proves insufficient. Alternative therapies such as demeclocycline, tolvaptan, and urea are limited to selected cases due to frequent side effects, high cost, and low availability, respectively. This case report explores the potential of empagliflozin as a novel treatment option. A 32-year-old female with SIAD following a traumatic subarachnoid hemorrhage experienced persistent hyponatremia despite fluid restriction and initial treatment with hypertonic saline and tolvaptan. Treatment with severe fluid restriction of 800 milliliters/day (mL/day) for almost a year led to significant impairment in her quality of life. Empagliflozin 25 milligrams/day was then initiated, resulting in sustained normonatremia for 16 months, the longest reported duration to date. This allowed increased fluid intake (1750 mL/day) and improved quality of life. Empagliflozin shows potential for managing chronic SIAD; prospective studies are needed to validate its efficacy and safety.