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The European guidelines* on the use if urea recommend the following dose: 0.25-0.50g/Kg (a 140lb person then would take 15.75 - 31.5g) UpToDate discusses a daily dose of 30g of urea. Typical in-patient dosing ranges between 15-60g/day BID Typical out-patient dosing ranges between 15-30g/day BID but doses of 60g/day BID are sometimes used. In some situations, providers have success dosing ure-Na 15g TIW.

UreaPro™ is pharmaceutical grade (USP) synthetically derived urea with a proprietary masking formula, which makes it palatable. It is known that hyponatremia is rarely a sodium deficiency, but rather an excess of water in the blood relative to sodium. Urea normalizes sodium levels in the blood by inducing water loss in the urine. This is accomplished without a risk of loss of important electrolytes like potassium, calcium and magnesium. Treatment with urea is particularly helpful in cases of SIADH (Syndrome of inappropriate ADH secretion).

In a comparison study of urea versus vaptans, urea had similar efficacy raising serum sodium to 135 mEq/L. (Soupart A: Efficacy and Tolerance of Urea Compared with Vaptans for Long-Term Treatment of Patients with SIADH. CJASN Vol 7 May, 2012.) In another study of the use of urea in an ICU setting, urea raised serum sodium 4 mmol/L the first day of use, and 7 mmol/L in 48 hours. (Decaux et al: Treatment of euvolemic hyponatremia in the intensive care unit by urea., Critical Care 2010 14:R184.) This rate of rise is very important from a safety standpoint, because too rapid a rise of serum sodium levels can be dangerous, and even life threatening. The above study showed that the rise was within the recommended levels of raising serum sodium levels less than 9mmol/L in the first 24 hours.

The risks of taking urea are very low. No long term toxicity has been seen. There is a very low risk of hypernatremic dehydration if your patients thirst center is intact. (Decaux G: Urea for long term treatment of syndrome of inappropriate secretion of antidiuretic hormone. BMJ Vol 283 24 Oct 1981.).