Syndrome of inappropriate antidiuretic hormone medical therapy: Difference between revisions
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*[[Oral salt tablets]] with [[loop diuretics]] | *[[Oral salt tablets]] with [[loop diuretics]] | ||
''Severe'': | '''Severe''': | ||
* 3% [[hypertonic saline]]( if sodium level falls below 125meq/l ) | * 3% [[hypertonic saline]]( if sodium level falls below 125meq/l ) | ||
'''Emergency setting''': | '''Emergency setting''': | ||
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'''Miscellaneous''' | '''Miscellaneous''' | ||
*[[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 | *[[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 | ||
*[[Urea:]] Urea, at a dose of 30 g/day, increases urinary solute excretion and enhances water excretion | *[[Urea:]] Urea, at a dose of 30 g/day, increases urinary solute excretion and enhances water excretion | ||
*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 | *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]] | ||
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*In rare medical emergencies more commonly seen in cardiology in the context of [[hypervolemic]] severe hyponatremia rather than in [[SIADH]] | *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) | ** [[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 | **[[Slow, low-efficiency daily dialysis]] (SLEDD have been used to improve hyponatremia. These methods are invasive so their use is very limited | ||
==References== | ==References== | ||
<references /> | <references /> | ||
Revision as of 19:40, 29 August 2017
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Syndrome of inappropriate antidiuretic hormone Microchapters |
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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 of syndrome of inappropriate antidiuretic hormone depends on the etiology. For immediate improvement, all patients with SIADH require strict restriction of their dailywater intake and correction of serum sodium levels. The serum sodium can can be corrected depending on the initial sodium levels of the patient. Mild cases can be managed easily with exclusive fluid restriction. Moderate cases of SIADH are treated with loop diuretics and normal saline, whereas, 3% hypertonic saline may be used in severe cases. In emergency settings, Vasopressin-2 receptor antagonists ( conivaptan ortolvaptan) are used. The definitive treatment of SIADH involves treatment of the underlying condition. urea, demeclocycline and lithium are also used in the treatment of SIADH
Medical treatment of SIADH
The mainstay of therapy for SIADH
Mild:
- Fluid restriction
Moderate:
Severe:
- 3% hypertonic saline( if sodium level falls below 125meq/l )
Emergency setting:
- Vasopressin-2 receptor antagonists such as conivaptan or tolvaptan
Miscellaneous
- 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
- Urea: Urea, at a dose of 30 g/day, increases urinary solute excretion and enhances water excretion
- 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