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SIADH:
= Syndrome of Inappropriate ADH
Secretion Definition: levels of ADH are inappropriately elevated compared to bodys low osmolality, and ADH levels are not suppressed by further decreases in blood osmolality.
SIADH: causes
Irritation of CNS: meningitis, encephalitis,
brain tumors, brain hemorrhage, hypoxic insult, trauma, brain abscess, Guillain Barre, hydrocephalus Pulmonary disorders: pneumonia, asthma, positive end expiratory pressure ventilation, CF, TB, pneumothorax
hypothalamus, stored in the posterior pituitary Normally released into the bloodstream when osmo-receptors detect high plasma osmolality At the kidney, attaches to receptors in the collecting ducts, opens up water channels Water is passively reabsorbed along the kidneys medullary concentration gradient
disorientation, muscle cramps, anorexia, agitation Signs of water toxicity: nausea, vomiting, personality changes, confused, combative If Na < 110 mEq/L, seizures, bulbar palsies, hypothermia, stupor, coma
SIADH: treatment
Fluid restriction, maintenance If symptomatic, may actually need to
replace NaCl, can use hypertonic saline for example: 300cc/m2 of 1 % NS Diuretics such as lasix Treat underlying disorder, for example usually resolves after removal of lung carcinomas
DI = Diabetes Insipidus
Definition: inability to effectively conserve
urinary water Central: ADH not made or not released in the hypothalamic-pituitary axis Nephrogenic: ADH is released but not detected by the receptors in the kidney collecting ducts, often a sex-linked recessive condition, also due to renal pathology, electrolyte disorders, drugs
DI:
Make sure distinguish DI from conditions in
which the presence of non-absorbable, osmotically active solutes in the renal tubules prevent water re-absorption. Example: glucose loss in the urine of diabetics will decrease the tubule- medullary concentration gradient and even though ADH is there, water wont get passively reabsorbed
b/c of hyper-osmolarity, fluid shifts from cells to intravascular spaces and maintains blood pressure, CVP Weight loss is a better measure of fluid status
DI
Urine Output polyuric
SIADH
decreased
CSW
polyuric
Serum Na
Urine Na Serum osm Urine osm
high
low high low Can be normal or low
low
high low high high
low
high Can be low or normal Can be low or normal low
CVP