SIADH

Diagnostic criteria:
 Euvolumic
 Plasma osmol <270
 Urine Osmol >100
 Urinary Na >40

Treatment:
 Water restriction (At least 500 ml, 1000 ml required) in all stages.
 Normal Saline, 3% NaCl,
 Stop Saline when Na reaches to 125 meq/l
 NaCl Tab (2 gm tds)
 Vasopressin receptor blocker: Tolveptan, Conivaptan
 Demeclocycline 300 mg
 3% Nacl + Frusemide
 Severe SIADH (Na <105): 3% Nacl + Frusemide
Why Fluid restriction not done in Ward?
 SIADH & CSWS can not be differentiated
(Investigation Plasma & Urinary Osmol + Na not done urgent)
 If its CSWS, fluid restriction in dehydrated patient can cause Ischemia.
 Normal Saline is safe in both side.

How Demeclocycline works in SIADH?

 A tetracycline antibiotic used in acne, Lyme disease, Bronchitis.
 Physiologically works by reducing the responsiveness of the collecting
tubule cells to ADH.
 The use in SIADH actually relies on a side effect;
Demeclocycline induces nephrogenic diabetes insipidus (dehydration due to
the inability to concentrate urine).