Syndrome of inappropriate antidiuretic hormone medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Treatment of syndrome of inappropriate antidiuretic hormone depends on the cause. For immediate improvement, all patients with SIADH require sharp restriction of their daily water intake and addition an intravenous infusion of fluid with a high concentration of sodium. (hypertonic saline solution). And, patients may be treated with diuresis to promote water excretion. The most definitive way to relieve SIADH is to deal with the underlying problem itself. If SIADH produced by drugs, then the patient must stop taking the medicine. If some infection may be the cause, the patient needs to controlling them by some antibiotics or other anti-microbiological drugs.
Medical Therapy
- Fluid restriction
- Intravenous saline
- Drugs
- Demeclocycline
- Conivaptan - an approved antagonist of both V1A and V2 vasopressin receptors. Its indications are "treatment of euvolemic hyponatremia (e.g. the syndrome of inappropriate secretion of antidiuretic hormone, or in the setting of hypothyroidism, adrenal insufficiency, pulmonary disorders, etc.) in hospitalized patients."[1]
- Tolvaptan - an unapproved oral antagonist of the V2 vasopressin receptor. A randomized controlled trial showed conivaptan that can raise the serum sodium by 5 mmol/L. [2]
Care must be taken when correcting hyponatremia. A rapid rise in the sodium level may cause central pontine myelinolysis.[3]
References
- ↑ "Vaprisol (conivaptan hydrochloride) Liquid [Astellas Pharma US, Inc.]".
- ↑ Schrier RW, Gross P, Gheorghiade M; et al. (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.
- ↑ Ashrafian H, Davey P (2001). "A review of the causes of central pontine myelinosis: yet another apoptotic illness?". Eur. J. Neurol. 8 (2): 103–9. PMID 11430268.