Transcript SIADH - ภาควิชากุมารเวช

SIADH
Monton
1 กค 48
Hyponatremia
exclude pseudohyponatremia
volume status
Hypovolemia
Euvolemia
Hypervolemia
Hypervolemia
Congestive heart failure
Cirrhosis
Nephrotic syndrome
Renal failure
Hypovolemia
Renal loss
Extrarenal loss
gastrointestinal loss
skin loss
third space loss
Euvolemia
SIADH
Adrenal insufficiency
Hypothyroidism
Primary polydipsia
SIADH
Nonphysiologic release of ADH
Not due to usual stimuli or hypoosmolarity
or hypovolemia
Inappropriate urinary concentration
Hyponatremia ,hypoosmolarity
High urine osmolarity
Pathophysiology
Persistent ADH activity
Water retention
Volume expansion
Stimulate volume receptors
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Carotid sinus, aortic arch  SNS
Left atrium  ANP
Juxtaglomerular apparatus  RAAS
Sodium & water excretion (secondary)
Pathophysiology
Water retention
Na,H2O excrete
hypoosmolarity
hyponatremia
Etiology
Neuropsychiatric disorder
Pulmonary disease
Drug
Postoperative patient
Carcinoma
Neuropsychiatric disorder
Infection
Vascular
Neoplasm
Psychosis
Others
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HIV infection
Pulmonary disease
Pneumonia
TB
Acute respiratory failure
Others
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Asthma
Atelectasis
Pneumothorax
Drugs
Cyclophosphamide – IV form
Carbamazepine
Haloperidol
Amitriptyline
Fluoxetine
Carcinoma
Small cell lung cancer
Duodenum
Pancreas
etc.
Diagnosis
Hyponatremia,Hypoosmolarity
Euvolemia , mild hypervolemia
Urine osmolarity > 100 mOsm/kg
Urine Na > 40 mEq/l or < 10 mEq/l
Hypouricemia
Clinical setting
Exclude adrenal insufficiency,
hypothyroidism & other hyponatremia
Treatment
Water restriction
Salt administration
Loop diuretic
Demeclocycline or lithium
Vasopressin receptor antagonist
Water restriction
aim to negative water balance
Salt administration
principle : effective osmolarity of the
fluid given must be greater
than that of the urine
eg. If Uosm = 700 mOsm/kg
NSS is inappropriate
3%NaCl is appropriate
Loop diuretic
Collecting tubule
mTALH
Na
H2O
K
2Cl
ADH
ADH antagonizing effect
Demeclocycline
Lithium
Incompletely understand
Vasopressin receptor antagonist
Selective water diuresis