Syndrome of inappropriate antidiuretic hormone medical therapy: Difference between revisions
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* 3% | * [[3% hypertonic saline]] | ||
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*Raise serum sodium by 0.5-1 mEq/hr, and not more than 10-12 mEq in the first 24 hours,to avoid complications like Osmotic demyelination syndrome. | |||
*In rare medical emergencies more commonly seen in cardiology in the context of hypervolemic severe hyponatremia rather than in SIADH : | |||
* Continuous veno-venous hemofiltration (CVVH) | |||
*Slow, low-efficiency daily dialysis (SLEDD have been used to improve hyponatremia. These methods are invasive so their use is very limited.<ref name="pmid19628685">{{cite journal |vauthors=Salahudeen AK, Kumar V, Madan N, Xiao L, Lahoti A, Samuels J, Nates J, Price K |title=Sustained low efficiency dialysis in the continuous mode (C-SLED): dialysis efficacy, clinical outcomes, and survival predictors in critically ill cancer patients |journal=Clin J Am Soc Nephrol |volume=4 |issue=8 |pages=1338–46 |year=2009 |pmid=19628685 |pmc=2723965 |doi=10.2215/CJN.02130309 |url=}}</ref> | |||
==References== | ==References== | ||
Revision as of 13:50, 15 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]
Overview
Treatment ofsyndrome of inappropriate antidiuretic hormone depends on the etiology. The mainstay of therapy is fluid]] restriction. Depending on thesodium levels and symptoms, 3% hypertonic saline and loop diuretics with normal saline may be used. In emergency settings,vasopressin-2 receptor antagonists such as (conivaptan or tolvaptan) are used. The most definitive way to treat SIADH is to deal with the underlying problem itself.
Medical treatment of SIADH
The mainstay of therapy for SIADH is
- Fluid restriction
- 3% hypertonic saline( if sodium level falls below 125meq/l ).
- Oral salt tablets with loop diuretics.
- Vasopressin-2 receptor antagonists such as conivaptan or tolvaptan used in severe hyponatremia in emergency setting. The use of V2 receptor antagonists is limited due to increased thirst, rapid correction of sodium and high cost.[1][2]
- Demeclocycline:It is a tetracycline derivative which induces drug-induced diabetes insipidus by acting on the collecting tubule cell to diminish its responsiveness to ADH.The role is limited in emergency care due to the slow onset of action.[3]
- Urea: Urea, at a dose of 30 g/day, increases urinary solute excretion and enhances water excretion.[4][5]
- Special consideration: Hyponatremia is the most common electrolyte abnormality in SIADH. So, the rate at which sodium is corrected is very important in clinical settings. It depends on the degree of hyponatremia, duration (acute or chronic),and symptomatology.
| Acute hyponatremia | Chronic hyponatremia |
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- Raise serum sodium by 0.5-1 mEq/hr, and not more than 10-12 mEq in the first 24 hours,to avoid complications like Osmotic demyelination syndrome.
- In rare medical emergencies more commonly seen in cardiology in the context of hypervolemic severe hyponatremia rather than in SIADH :
- Continuous veno-venous hemofiltration (CVVH)
- Slow, low-efficiency daily dialysis (SLEDD have been used to improve hyponatremia. These methods are invasive so their use is very limited.[6]
References
- ↑ Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS, Orlandi C (2006). "Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia". N. Engl. J. Med. 355 (20): 2099–112. doi:10.1056/NEJMoa065181. PMID 17105757.
- ↑ Pillai BP, Unnikrishnan AG, Pavithran PV (2011). "Syndrome of inappropriate antidiuretic hormone secretion: Revisiting a classical endocrine disorder". Indian J Endocrinol Metab. 15 Suppl 3: S208–15. doi:10.4103/2230-8210.84870. PMC 3183532. PMID 22029026.
- ↑ Cox M, Guzzo J, Morrison G, Singer I (1977). "Demeclocycline and therapy of hyponatremia". Ann. Intern. Med. 86 (1): 113–4. PMID 402098.
- ↑ Decaux G, Brimioulle S, Genette F, Mockel J (1980). "Treatment of the syndrome of inappropriate secretion of antidiuretic hormone by urea". Am. J. Med. 69 (1): 99–106. PMID 7386514.
- ↑ Decaux G, Genette F (1981). "Urea for long-term treatment of syndrome of inappropriate secretion of antidiuretic hormone". Br Med J (Clin Res Ed). 283 (6299): 1081–3. PMC 1507492. PMID 6794768.
- ↑ Salahudeen AK, Kumar V, Madan N, Xiao L, Lahoti A, Samuels J, Nates J, Price K (2009). "Sustained low efficiency dialysis in the continuous mode (C-SLED): dialysis efficacy, clinical outcomes, and survival predictors in critically ill cancer patients". Clin J Am Soc Nephrol. 4 (8): 1338–46. doi:10.2215/CJN.02130309. PMC 2723965. PMID 19628685.