Inappropriate Secretion of Antidiuretic Hormone (SIADH)

• Causes: head injuries,intracranial tumors, pulmonary infections, small cell

carcinoma of the lung and hypothyroidism.
Clinical manifestations
occur as a result of a dilutional hyponatremia, ↓ serum osmolality, and a reduced
urine output with a high osmolality. Weight gain, skeletal muscle weakness, and
mental confusion or convulsions are presenting symptoms. Peripheral edema
and hypertension are rare. The diagnosis of the (SIADH) is one of exclusion,
and other causes of hyponatremia must first be ruled out. The prognosis is
related to the underlying cause of the syndrome.
Treatment:
• Pt with mild/mod H2O intoxication is restriction of fluid intake to 800 ml·day–1.
• Pt with severe water intoxication associated with hyponatremia and mental
confusion may require more aggressive therapy, with the iv administration of a
hypertonic saline solution. This may be administered in conjunction with lasix
• Caution must be observed in patients with poor LV function. Isotonic saline is
substituted for hypertonic solutions once the serum Na is in a safe range.
• Too-rapid correction of hyponatremia may induce central pontine
myelinolysis and cause permanent brain damage.
• Serum sodium should not be raised by more than 12 mEq·l–1 in 24 hours.
• Other drugs that may be used in the patient with SIADH are demeclocycline
and lithium. Demeclocycline interferes with the ability of the renal tubules to
concentrate urine and is frequently used in outpatients. Lithium usually is not
used because of the high incidence of toxicity.