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SIADH

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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  1. SIADH Monton 1 กค48

  2. Hyponatremia excludepseudohyponatremia volume status Hypovolemia Euvolemia Hypervolemia

  3. Hypervolemia • Congestive heart failure • Cirrhosis • Nephrotic syndrome • Renal failure

  4. Hypovolemia • Renal loss • Extrarenal loss gastrointestinal loss skin loss third space loss

  5. Euvolemia • SIADH • Adrenal insufficiency • Hypothyroidism • Primary polydipsia

  6. SIADH • Nonphysiologic release of ADH • Not due to usual stimuli or hypoosmolarity or hypovolemia • Inappropriate urinary concentration • Hyponatremia ,hypoosmolarity • High urine osmolarity

  7. 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)

  8. Pathophysiology Water retention Na,H2O excrete hypoosmolarity hyponatremia

  9. Etiology • Neuropsychiatric disorder • Pulmonary disease • Drug • Postoperative patient • Carcinoma

  10. Neuropsychiatric disorder • Infection • Vascular • Neoplasm • Psychosis • Others • HIV infection

  11. Pulmonary disease • Pneumonia • TB • Acute respiratory failure • Others • Asthma • Atelectasis • Pneumothorax

  12. Drugs • Cyclophosphamide – IV form • Carbamazepine • Haloperidol • Amitriptyline • Fluoxetine

  13. Carcinoma • Small cell lung cancer • Duodenum • Pancreas • etc.

  14. 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

  15. Treatment • Water restriction • Salt administration • Loop diuretic • Demeclocycline or lithium • Vasopressin receptor antagonist

  16. 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

  17. Loop diuretic Collecting tubule mTALH Na H2O K 2Cl ADH

  18. ADH antagonizing effect • Demeclocycline • Lithium • Incompletely understand Vasopressin receptor antagonist • Selective water diuresis

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