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SIADH - Syndrome of Inappropriate Hormone Secretion ADH (anti-diuretic hormone) is a hormone made in the pituitary gland. Syndrome of Inappropriate Antidiuretic Hormone Secretion - SIADH SIADH occurs when there is too much vasopression (ADH) with inappropriate water retention and decreased blood Na levels Results from many different conditions and drugs May be produced by certain tumors such as lung cancer or may result from chronic lung diseases.
Assessment-Clinical Manifestations of SIADH Water retention, hyponatremia, & resulting fluid shifts have an effect on CNS function, especially when serum sodium level drops.
SIADH - Diagnostic Tests Blood & Urine tests Must have – low serum sodium –low plasma osmolality level –Inappropriated concentrated urine (increased urine osmolality level) These tests indicate –excess of body water relative to the amount of body sodium.
SIADH and Hyponatremia Hyponatremia - a lower than normal concentration of sodium in the blood Caused by inadequate excretion of water of by excessive water in the circulating bloodstream In a severe case the pt may experience water intoxication, with confusion and lethargy, leading to muscle excitability, convulsions, and coma. SIADH Treatment Water Restriction is the cornerstone of treatment Decreased water intake allows serum sodium level to rise normally.
Planning & Implementation Planning: Pt Goals The primary goal is that the pt’s fluid balance will be restored Interventions to treat SIADH (Pt Care Plan) consists of Restriction water intake Using diuretics to promote the excretion of water Administering drugs that interfere with the action of ADH Replacing lost sodium Fluid Restriction Any excessive free water intake will further dilute the serum sodium concentration Strict I&O, daily weights, guides the determination of the degree of fluid restriction necessary. The graph below details how the concentration of antidiuretic hormone (vasopressin) released from the anterior pituitary in response to dehydrated blood serum diagnoses the type of diabetes insipidus. Drawing illustrating how the posterior portion of the pituitary gland of the brain, by releasing the hormone ADH, signals the kidey to retain (conserve) water. Gestational diabetes insipidus occurs only during pregnancy when an enzyme made by the placenta destroys antidiuretic hormone in the mother. In this form of diabetes insipidus, also known as primary polydipsia or psychogenic polydipsia, excessive fluid intake leads to suppression of the antidiurtetic hormone.
Nephrogenic diabetes insipidus is a disorder in which a defect in the small tubes (tubules) in the kidneys causes a person to pass a large amount of urine.

New AVP receptor antagonists are currently undergoing phase III clinical trials and show promise for the treatment of hyponatraemia.A  The increase serum sodium by stimulating free water excretion. ADH contributes to fluid balance by –Controlling renal reabsorption of free water – It also has potent vasoconstrictive properties. ADH does what the name says - it stops urination - diuresis Slowing or stopping urine production leads to fluid retention.
Treatment : Fluid and electrolyte balance may be restored by IV infusion of a balanced solution or a fluid restricted diet. The maximum amount of water that pt with SIADH are allowed to drink is just slightly more that the amount of urine they produce Pt must have regular serum sodium measurements to ensure that the water restriction has been effective Dehydration- The most concerning potential side effect from treatment is dehydration. A wt gain of 2 pounds (or 1 Kg) or more per day or a gradual increase during several days is cause for concern.
If the pt needs routine IV fluids, the MD orders a solution in saline (5% dextrose in saline) rather than a solution in water. Abnormal thirst caused by damage to the thirst-regulating mechanism situated in the hypothalamus can ressult in drinking too much liquid and consequently a dangerous dilution of the electrolytes in the blood.
Our Team, headed by Mike Cadogan & Chris Nickson, consists (mostly) of emergency physicians and intensivists based in Australia and New Zealand. The Kidneys are mainly responsible for maintaining the concentration of body fluids within this range of osmolality.
Important to eliminate other causes of a low sodium level, such as hypothyroidism or adrenal insufficiency, before settling on a dx of SIADH Rx- removing the offending drug or tumor, & treat the underlying condition. The cause of such damage to the thirst center can result from diseases such as sarcoidosis, medications, and even mental illness (called psychogenic polydipsia).

ADH normally tells the kidneys to make the urine more concentrated. As a result of the defect, the kidneys release an excessive amount of water into the urine, producing a large quantity of very dilute urine. For acute severe (<120) and symptomatic hypotension (seizures, obtundation) 100ml of 3% over 10 minutes.
Low sodium levels often make pt nauseated If the situation is not corrected, seizures, coma, & even death can follow.
Flow sheets contain ongoing info about LOC, motor & sensory neuro assessment, & pertinent lab data helpful in detecting trends. Congenital diabetes insipidus is present at birth as a result of an inherited defect that usually affects men, although women can pass the gene on to their children. Most commonly, nephrogenic diabetes insipidus develops because of other reasons. You will produce large amounts of urine, usually more than 3 - 15 liters per day. If you do not drink enough fluids, dehydration can result. The amount of fluids given should be about equal to the amount of urine produced. If the condition is due to a certain medication, stopping the medicine may improve symptoms. Never stop taking any medication without first talking to your doctor. A medicine called hydrochlorothiazide may improve symptoms.

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