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Syndrome of Inappropriate Antidiuretic hormone

- Is an endocrine peraneoplastic syndrome that cause a disorder of

water balance. Antidiuretic hormone (ADH), also called arginine

vasopressin, regulates the body’s water balance, SIADH is

characterized by elevated serum blood levels of ADH, excessive water

retention, hypoosmolality, and hyponatremia.

Etiology and Risk Factors

- 1%- 2% develops in patients with cancer

- 80% lung cancer

- 50% of patients with SCLC have impaired water excretion.

Clinical Manifestation

Mild Hyponatremia: Serum sodium 125-135 mEq/L

May be asymptomatic

- Anorexia

- Difficulty concentrating

- Fatigue

- Headache

- Inappropriate behavior

- Muscle cramps

- Oliguria

- Peripheral edema

- Weakness

- Weight gain

Moderate Hyponatremia: Serum Sodium 115- 125 mEq/L

- Confusion
- Decreased deep tendon reflexes

- Hallucinations

- Impaired taste

- Incontinence

- Lethargy

- Nausea, vomiting, diarrhea

- Oliguria

- Personality changes

- Thirst

- Tremors

- Weight gain

Severe Hyponatremia: Serum Sodium 115 mEq/L

- Coma

- Seizure

- Inability to protect airway and mobilize secretions

Nursing Management

- Assess for signs or symptoms of alteration in fluid volume ( excess:

rales shortness of breath, neck vein distention, weight gain, and edema

of sacrum and / or lower extremities; deficit: dry mucous membranes,

poor skin turgor, weight loss, rapid and thread pulse, orthostatic

hypotension, and restlessness).

- Auscultate lungs for breath sounds.

- Monitor cardiac function and tissue perfusion.

- Restrict fluids as ordered (500 to 1000 ml/ 24 hr).


- Monitor laboratory values ( serum electrolytes, BUN, creatinine,

calcium, magnesium) with special attention to the following:

- Serum plasma osmolality: As SIADH progresses, plasma osmolality

decreases, which causes the brain to swell and level of consciousness

(LOC) to decrease. Therefore serum osmolality can predict LOC.

- Serum sodium: Hypernatremia may result from overcorrection of low

serum levels. Accompanying signs and symptoms of hypernatremia

include thirst, dry mucous membranes, irritability, lethargy, and

seizures

- Check muscles and tendon reflexes for twitching.

- Monitor skin integrity, and provide appropriate skin care.

- Thoroughly assess the oral cavity, and provide oral care as needed.