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SIADH. Monton 1 กค 48. Hyponatremia exclude pseudohyponatremia volume status Hypovolemia Euvolemia Hypervolemia . Hypervolemia. Congestive heart failure Cirrhosis Nephrotic syndrome Renal failure. Hypovolemia. Renal loss Extrarenal loss

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Presentation Transcript
siadh

SIADH

Monton

1 กค48

slide2
Hyponatremia

excludepseudohyponatremia

volume status

Hypovolemia Euvolemia Hypervolemia

hypervolemia
Hypervolemia
  • Congestive heart failure
  • Cirrhosis
  • Nephrotic syndrome
  • Renal failure
hypovolemia
Hypovolemia
  • Renal loss
  • Extrarenal loss

gastrointestinal loss

skin loss

third space loss

euvolemia
Euvolemia
  • SIADH
  • Adrenal insufficiency
  • Hypothyroidism
  • Primary polydipsia
siadh1
SIADH
  • Nonphysiologic release of ADH
  • Not due to usual stimuli or hypoosmolarity or hypovolemia
  • Inappropriate urinary concentration
  • Hyponatremia ,hypoosmolarity
  • High urine osmolarity
pathophysiology
Pathophysiology
  • Persistent ADH activity
  • Water retention
  • Volume expansion
  • Stimulate volume receptors
    • Carotid sinus, aortic arch  SNS
    • Left atrium  ANP
    • Juxtaglomerular apparatus  RAAS
  • Sodium & water excretion (secondary)
pathophysiology1
Pathophysiology

Water retention Na,H2O excrete

hypoosmolarity

hyponatremia

etiology
Etiology
  • Neuropsychiatric disorder
  • Pulmonary disease
  • Drug
  • Postoperative patient
  • Carcinoma
neuropsychiatric disorder
Neuropsychiatric disorder
  • Infection
  • Vascular
  • Neoplasm
  • Psychosis
  • Others
    • HIV infection
pulmonary disease
Pulmonary disease
  • Pneumonia
  • TB
  • Acute respiratory failure
  • Others
    • Asthma
    • Atelectasis
    • Pneumothorax
drugs
Drugs
  • Cyclophosphamide – IV form
  • Carbamazepine
  • Haloperidol
  • Amitriptyline
  • Fluoxetine
carcinoma
Carcinoma
  • Small cell lung cancer
  • Duodenum
  • Pancreas
  • etc.
diagnosis
Diagnosis
  • Hyponatremia,Hypoosmolarity
  • Euvolemia , mild hypervolemia
  • Urine osmolarity > 100 mOsm/kg
  • Urine Na > 40 mEq/l or < 10 mEq/l
  • Hypouricemia
  • Clinical setting
  • Exclude adrenal insufficiency, hypothyroidism & other hyponatremia
treatment
Treatment
  • Water restriction
  • Salt administration
  • Loop diuretic
  • Demeclocycline or lithium
  • Vasopressin receptor antagonist
slide16
Water restriction

aim to negative water balance

Saltadministration

principle : effective osmolarity of the fluid given must be greater than that of the urine

eg. If Uosm = 700 mOsm/kg

NSS is inappropriate

3%NaCl is appropriate

loop diuretic
Loop diuretic

Collecting tubule

mTALH

Na

H2O

K

2Cl

ADH

adh antagonizing effect
ADH antagonizing effect
  • Demeclocycline
  • Lithium
  • Incompletely understand

Vasopressin receptor antagonist

  • Selective water diuresis