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Di, Siadh, CSW
Di, Siadh, CSW
2/18/2011
SIADH
Inappropriate secretion of ADH
Water excretion is impaired
Suppression of ADH is impaired
Functions of ADH
Increases permeability of water in the cells of the distal
tubules by upregulating Aquaporin-2 channels (V2
receptors)
Increases the permeability of collecting ducts to urea
Increases SVR via IP3/Ca++ 2nd messengers on endothelium
CNS effects like memory formation and circadian rhythm
SIADH - causes
Intracranial – infection, stroke, hemorrhage, tumor, very common
in SAH population (69%)
Intrathoracic – malignancy, abscess, PNA, effusion, PTX, chest wall
deformity
Drugs – vasopressin, DDAVP, oxytocin, analgesics, antidepressants,
amiodarone, antipsychotics, sulfonylureas, carbamazepine,
cyclophosphamide
Extracranial tumors – small-cell lung CA, pancreatic CA
HIV/AIDS
Hereditary – “gain-of-function” V2 receptor mutation
Miscellaneous – Guillan-Barre, nausea, stress, pain, acute psychosis
Major surgery ****
Idiopathic
SIADH
Hypothalamus receives
feedback from:
• Osmoreceptors
• Aortic arch baroreceptors
• Carotid baroreceptors
• Atrial stretch receptors
used)
Review
SIADH CSW DI
Serum Na+ < 135 mEq/L < 135 mEq/L > 145 mEq/L
Urine Na+ > 25 mEq/L > 40 mEq/L < 25 mEq/L
Serum Osm < 270 mOsm/kg < 270 mOsm/kg > 285 mOsm/kg
Urine Osm > 300 mOsm/kg > 300 mOsm/kg < 300 mOsm/kg
Urine O/P oliguria polyuria polyuria
CVP normal/high low normal/low
Plasma ADH high normal low
Rx Fluid restrict, give Give volume, give Drink to thirst,
Na+, vaprisol, Na+, DDAVP (central),
demeclocycline fludrocortisone HCTZ (nephrogenic)