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SIADH: Diagnosis and Treatment

by Carlo Raj, MD
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    Let’s talk further about SIADH. History and physical for sure; findings, here you go. Euvolemic patient, what does that mean? What’s eu- mean, the prefix? It means normal. You’ve heard of euthyroid, here we have euvolemia, what does that mean? Even though you know for a fact your patient has, for whatever reason, increased ADH functioning, you’re going to reabsorb more water from the collecting duct and one would think that your patient, for sure, has pitting edema. Nope, because how much sodium would you have in your interstitium compared to a patient who has right-sided heart failure and strictly transudate? Decreased sodium and SIADH. Your patient is not going to present with pitting edema or significant pitting edema. Serum sodium levels and plasma osmolarity, ridiculously low. What about urine osmolarity? High. Plasma osmolarity? Low. Urine sodium? Low... Low BUN, serum uric acid, everything is being diluted, diluted, diluted. Now, at the very bottom of this, it’s important, SIADH cannot be diagnosed without excluding hypothyroidism and adrenal insufficiency. Once again, keep in mind that whenever you are dealing with ADH, other endocrine dysfunctions, especially thyroid and the adrenals, are important for you to make sure that you rule out. What do you want to do? Always come to the underlying cause. If your issue was a lung cancer, completely different steps of management. If your patient was on drugs, which is carbamezapine, obviously remove the offending agent. Whatever it may be, you want to keep things in mind, pulmonary disease and treatment, cessation of drugs, hormonal replacement and adrenal insufficiency or even perhaps hypothyroidism. Things... These are things that you are paying attention to when dealing with SIADH. Restrict free water intake. Here, once again, caution must be exercised with patients with SIADH secondary to subarachnoid haemorrhage due to exacerbation...

    About the Lecture

    The lecture SIADH: Diagnosis and Treatment by Carlo Raj, MD is from the course Pituitary Gland Disorders.


    Included Quiz Questions

    1. Low plasma osmolarity, low serum sodium, euvolemia
    2. High plasma osmolarity, low serum sodium, euvolemia
    3. Low plasma osmolarity, low serum sodium, hypovolemia
    4. Low plasma osmolarity, high serum sodium, hypovolemia
    5. High plasma osmolarity, high serum sodium, euvolemia
    1. Hypothyroidism
    2. Diabetes mellitus
    3. Adrenal hyperactivity
    4. Sheehan's syndrome
    5. Hyperparathyroidism
    1. Electrolyte concentration of fluid must be greater than plasma but not greater than urine
    2. Free water intake must be restricted
    3. IV saline must be administered gradually to avoid central pontine myelinolysis
    4. Electrolyte concentration of fluid must be greater than that of the urine
    5. Hypertonic saline must be administered with caution
    1. When the patient is refractory to other therapies with ADH receptor antagonists
    2. In patients with liver disease
    3. In patients who require PO medication
    4. Long term therapy is indicated
    5. In order to block V1 and V2 receptors

    Author of lecture SIADH: Diagnosis and Treatment

     Carlo Raj, MD

    Carlo Raj, MD


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