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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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SIADH

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Siadh

SIADH

Monton

1 กค48


Siadh

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


Siadh

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


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