Syndrome of inappropriate antidiuretic hormone secretion: Difference between revisions
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***[[Subdural hematoma]]
***[[Subdural hematoma]]
**Other
**Other
***Acute intermittent porphyria
***[[Acute intermittent porphyria]]
***Cerebellar and cerebral atrophy
***Cerebellar and cerebral atrophy
***CNS lupus
***CNS [[lupus]]
***[[Epilepsy]], [[Delirium tremens]]
***[[Epilepsy]], [[Delirium tremens]]
***[[Multiple sclerosis]], [[Guillain-Barré Syndrome]]
***[[Multiple sclerosis]], [[Guillain-Barré Syndrome]]
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*Ectopic ADH secretion due to neoplastic source
*Ectopic ADH secretion due to neoplastic source
**Lung carcinoma, mesothelioma
**Lung carcinoma, mesothelioma
**Duodenal, pancreatic, and colonic carcinomas
**Duodenal, pancreatic, and [[colon cancer|colonic carcinomas]]
**Adrenocortical, bladder/urothelial, ovarian, prostate, and cervical cancers
**Adrenocortical, bladder/urothelial, ovarian, prostate, and cervical cancers
**[[Brain tumor]], [[leukemia]]/[[lymphoma]], carcinoid, neuroblastoma, thymoma, Ewing's sarcoma
**[[Brain tumor]], [[leukemia]]/[[lymphoma]], carcinoid, neuroblastoma, thymoma, Ewing's sarcoma
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***[[Barbiturates]], [[thiopental]], [[Mono amine oxidase inhibitor toxicity|MAOIs]], [[tricyclic antidepressants]]
***[[Barbiturates]], [[thiopental]], [[Mono amine oxidase inhibitor toxicity|MAOIs]], [[tricyclic antidepressants]]
***[[Opioids]]
***[[Opioids]]
***[[Haloperidol]], phenothiazines
***[[Haloperidol]], [[phenothiazines]]
***[[Carbamazepine]], [[oxcarbazepine]]
***[[Carbamazepine]], [[oxcarbazepine]]
***Halothane, [[nitrous oxide]]
***Halothane, [[nitrous oxide]]
***Bromocriptine
***[[Bromocriptine]]
***Carbachol
***Carbachol
**Chlorpropamide
**Chlorpropamide
***[[Isoproterenol]]
***[[Isoproterenol]]
***Nicotine
***[[nicotine toxicity|Nicotine]]
**ADH-potentiating
**ADH-potentiating
***[[Griseofulvin]]
***[[Griseofulvin]]
***Hypoglycemic agents – Metformin, phenformin, tolbutamide
***Hypoglycemic agents – [[Metformin]], phenformin, tolbutamide
***Oxytocin (large doses)
***[[Oxytocin]] (large doses)
***[[Indomethacin]], [[aspirin]], [[NSAIDs]]
***[[Indomethacin]], [[aspirin]], [[NSAIDs]]
***[[Theophylline]]
***[[Theophylline]]
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*Effective serum osmolality <275 mOsm/kg
*Effective serum osmolality <275 mOsm/kg
*Urine osmolality >100 mOsm/kg at some level of decreased effective osmolality
*Urine osmolality >100 mOsm/kg at some level of decreased effective osmolality
*Clinical euvolaemia
*Clinical euvolemia
*Urine sodium concentration >30 mmol/l with normal dietary salt and water intake
*Urine [[hyponatremia|sodium concentration]] >30 mmol/l with normal dietary salt and water intake
*Absence of adrenal, thyroid, pituitary or renal insufficiency
*Absence of adrenal, thyroid, pituitary or renal insufficiency
*No recent use of diuretic agents
*No recent use of [[diuretic]] agents


===Supplemental criteria===
===Supplemental criteria===
*Serum uric acid <0.24 mmol/l (<4mg/dl)
*Serum uric acid <0.24 mmol/l (<4mg/dl)
*Serum urea <3.6 mmol/l (<21.6mg/dl)
*Serum urea <3.6 mmol/l (<21.6mg/dl)
*Failure to correct hyponatraemia after 0.9% saline infusion
*Failure to correct [[hyponatremia]] after 0.9% saline infusion
*Fractional sodium excretion >0.5%
*Fractional sodium excretion >0.5%
*Fractional urea excretion >55%
*Fractional urea excretion >55%
*Fractional uric acid excretion >12%
*Fractional uric acid excretion >12%
*Correction of hyponatraemia through fluid restriction
*Correction of [[hyponatremia]] through fluid restriction


==Management<ref>Verbalis JG et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013 Oct;126(10 Suppl 1):S1-42.</ref>==
==Management<ref>Verbalis JG et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013 Oct;126(10 Suppl 1):S1-42.</ref>==

Revision as of 16:53, 29 September 2019

Background

  • Abbreviation: SIADH
  • Inappropriate or continued action of ADH despite normal/increased plasma volume→ impaired water excretion→ hyponatremia and hypo-osmolality

Clinical Features

  • See hyponatremia
  • Symptoms of neoplasm, particularly lung neoplasm

Differential Diagnosis (Causes)

Evaluation

Essential Criteria[1]

  • Effective serum osmolality <275 mOsm/kg
  • Urine osmolality >100 mOsm/kg at some level of decreased effective osmolality
  • Clinical euvolemia
  • Urine sodium concentration >30 mmol/l with normal dietary salt and water intake
  • Absence of adrenal, thyroid, pituitary or renal insufficiency
  • No recent use of diuretic agents

Supplemental criteria

  • Serum uric acid <0.24 mmol/l (<4mg/dl)
  • Serum urea <3.6 mmol/l (<21.6mg/dl)
  • Failure to correct hyponatremia after 0.9% saline infusion
  • Fractional sodium excretion >0.5%
  • Fractional urea excretion >55%
  • Fractional uric acid excretion >12%
  • Correction of hyponatremia through fluid restriction

Management[2]

  • See hyponatremia
  • Fluid restriction
  • Oral salt tablets (NaCl) for mild-moderate hyponatremia
  • 100 cc bolus of 3% NaCl for severe symptoms, repeat if neurologic symptoms persist or worsen
    • Ideally given through central line
  • DO NOT give normal saline 0.9%
    • In SIADH, sodium handling is intact and renal system will excrete Na
    • Water handling out of balance from excessive ADH
    • All sodium will be excreted, urine osmolality will remain high
    • Half of the bolus of normal saline will be retained, worsening hyponatremia
  • See osmotic demyelination syndrome for excessively rapid overcorrection

Disposition

References

  1. ↑ Schwartz WB, Bennett W, Curelop S, Bartter FC. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. American Journal of Medicine 1957 23 529–542
  2. ↑ Verbalis JG et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013 Oct;126(10 Suppl 1):S1-42.
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