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Di, Siadh, CSW
Di, Siadh, CSW
Di, Siadh, CSW
2/18/2011
SIADH
Inappropriate secretion of ADH
Water excretion is impaired
Suppression of ADH is impaired
Functions of ADH
Increases permeability of water in the cells of the distal
SIADH - causes
Intracranial infection, stroke, hemorrhage, tumor, very
SIADH
Hypothalamus
receives feedback
from:
Osmoreceptors
Aortic arch
baroreceptors
Carotid
baroreceptors
Atrial stretch
receptors
Any increase in
osmolality or
decrease in blood
volume will stimulate
ADH secretion from
SIADH - pathophysiology
ADH-induced water retention
Dilutional hyponatremia
Volume expansion -> secondary natriuresis
Sodium and water loss
Potassium loss
Result: Euvolemic hyponatremia
Reduced serum osmolality
Increased urine osmolality
Increased urine sodium
SIADH - diagnosis
Laboratory Findings
Na < 135 mEq/L
Posm < 270 mOsm/kg
Uosm > 300 mOsm/kg
UNa > 25 mEq/L
Low BUN
Normal Cr
Low uric acid
Low albumin
SIADH - treatment
Treat the underlying cause, if known
Fluid Restriction commonly 800-1000mL/d
Correct Na+ deficit no more than 10mEq/L
SIADH treatment
Vasopressin receptor antagonists
Promote aquaresis
Tolvaptan, conivaptan
Vaprisol (Conivaptan)
Indicated in euvolemic or hypervolemic
hyponatremia
Contraindicated in hypovolemic hyponatremia
V1a and V2 receptors
Causes aquaresis or excretion of free water
Diabetes Insipidus
The most common cause of hypernatremia in
neurological population
Deficient ADH
Central DI occurs with hypothalamic-pituitary
Diabetes Insipidus
Diabetes Insipidus
Typical Clinical picture:
Polyuria
Polydipsia
Laboratory Findings
Na >145 mEq/L
Nocturia
Posm > 285 mOsm/kg
Uosm < 300 mOsm/kg
UNa low
Urine Spec. Grav. < 1.005
UOP > 3ml/kg/h
Diabetes Insipidus
Goal is to restore plasma volume and serum
Na+ levels
Patient with intact thirst mechanism
Severe forms
Review
SIADH
CSW
DI
Serum Na+
Urine Na+
> 25 mEq/L
> 40 mEq/L
< 25 mEq/L
Serum Osm
Urine Osm
Urine O/P
oliguria
polyuria
polyuria
CVP
normal/high
low
normal/low
Plasma ADH
high
normal
low
Rx
Fluid restrict,
give Na+,
vaprisol,
demeclocycline
Give volume,
give Na+,
fludrocortisone
Drink to thirst,
DDAVP
(central), HCTZ
(nephrogenic)