Diagnostic Procedure

In addition to a complete medical history and physical examination, to confirm diagnosis of

SIADH, blood and urine tests will need to be performed to measure sodium, potassium, and
osmolality (concentration of solution in the blood and urine) may allow for further
discrimination and may be indicative for a specific underlying disorder, causing SIADH. 

Fluid Status
- Patients with SIADH are typically euvolemic or hypervolaemic (i.e. not dehydrated).
Hypervolemic hyponatremia: Increase in total body sodium with greater increase in total
body water. Euvolemic hyponatremia: Normal body sodium with increase in total body
water.
- If dehydration is present, it may suggest an alternative cause for the hyponatraemia (e.g.
diuretic-related, renal failure).

In SIADH it's going to be a low serum osmolality low serum sodium (the hyponatremia) high urine
osmolality, high urine sodium.
Blood Test
Serum sodium: low in SIADH (<130 mmol/L). In most people with SIADH, drinking water doesn't
adequately suppress ADH release, and their pee remains concentrated. This leads to water
retention, which dilutes your blood. This then leads to low levels of sodium in your blood
(hyponatremia)
Plasma osmolality: reduced in SIADH (due to low serum sodium).
Serum cortisol: should be checked to rule out Addison’s disease as a cause of hyponatraemia
(cortisol is reduced in Addison’s disease).
the low serum osmolality and the low serum sodium, if you have inappropriate levels of ADH that
add hydration hormone you're going to see a dilution of the serum osmolality in the serum sodium

Urine Test
Urine Osmolality - in healthy individuals, if serum osmolality is low, urine osmolality should also
be low as the kidneys should be working hard to retain solute. In SIADH, the excess of ADH results
in water retention, but not solute retention. As a result, concentrated urine which is relatively high
in sodium is produced, despite low serum sodium.
urine osmolality elevated in siadh again ADH is acting on the nephron to reabsorb water so what's
left behind is concentrated therefore having a high urine osmolality.
Urine Sodium - With SIADH, the urine is very concentrated. Not enough water is excreted and
there is too much water in the blood. This dilutes many substances in the blood such as sodium.
what about the urine sodium why is that elevated in ADH well remember in SIADH these patients
are euvolemic to hypervolemic so as you reabsorb water and you expand the extracellular fluid
volume this causes the cells in the atria to also stretch which prompts them to release the natural
uretic peptide leading to natural uresis or loss of sodium in the urine and that's why the urine
sodium is elevated