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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 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 HIV infection Pulmonary disease Pneumonia TB Acute respiratory failure Others 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
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