1 / 18

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Objectives. The learner will be able to: Describe the pathophysiology of SIADH. Identify appropriate clinical management of SIADH. Description.

magee
Télécharger la présentation

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

  2. Objectives The learner will be able to: • Describe the pathophysiology of SIADH. • Identify appropriate clinical management of SIADH.

  3. Description • Inappropriate secretion of antidiuretic hormone, inappropriate for feedback mechanisms, leading to fluid and electrolyte disturbances • Kidneys absorb free water, despite normal blood volume and intravascular osmolality, resulting in low sodium levels (hyponatremia) and concentrated urine output.

  4. Normal Secretion of ADH • Regulated by receptors in the kidneys, heart, and hypothalamus in response to: • Elevated serum osmolality • Low blood pressure or volume

  5. Inappropriate ADH Secretion • Malignancy • Central nervous system disorders • Pulmonary disease • Stress/pain • Dehydration

  6. Risk Related to Malignancy • Lung cancer • Small cell lung cancer (80%) • Primary brain tumors • Other • Pancreas • Duodenum/colon • Bladder/prostate

  7. Other Risks • Advanced age • Tobacco use • Medications • Opioids • Antidepressants • NSAIDs • Anesthetics

  8. Significance • Hyponatremia • Seizures • Coma • Death

  9. Symptoms • Mild hyponatremia (125134 mEq/L) • Thirst • Anorexia • Nausea • Headache • Muscle cramps or weakness

  10. Symptoms (cont.) • Moderate hyponatremia (115124 mEq/L) • Weight gain • Oliguria • Increasing neurologic manifestations

  11. Symptoms (cont.) • Severe hyponatremia (<115 mEq/L) • Papilledema • Delirium • Hypoactive reflexes • Ataxia

  12. Diagnosis • Low serum sodium (<135 mEq/L) • Low serum osmolality (<275 mOsm/kg) • Low BUN • Elevated urine sodium (>220 mEq/24 hrs) • Elevated urine osmolality (>1,200 mOsm/kg water • Elevated urine specific gravity (>1.032)

  13. Treatment • Treat underlying malignancy. • Free water restriction (5001,000 ml/day) • Discontinue problematic drug therapy. • Pharmacologic inhibition of ADH • Demeclocycline • Lithium • Hypertonic saline (3%5%)

  14. Goals of Therapy • Slow adjustment of sodium level • 125130 mEq/L • Avoid fluid overload. • Minimize hypotonic solutions. • Add furosemide with hypertonic therapies. • Prevent central pontine myelinolysis.

  15. Nursing Management • Early recognition of risk • Monitor intake/output and weight. • Monitor electrolytes (sodium). • Monitor mental status. • Monitor neurologic signs. • Provide client and family education.

  16. Dealing With Fluid Restriction • Space fluids evenly throughout the day. • Include high-sodium fluids. • Broth, tomato/orange juice, and milk • Perform oral care q two to four hours. • Use artificial saliva or oral moisturizers. • Suggest sugarless gum/candy. • Avoid alcohol mouthwashes or nicotine products.

  17. References Clancey, J.K. (2006). Syndrome of inappropriate antidiuretic hormone secretion. In M. Kaplan (Ed.),Understanding and managing oncologic emergencies: A resource for nurses (pp. 197217). Pittsburgh, PA: Oncology Nursing Society. Flounders, J.A. (2003). Syndrome of inappropriate antidiuretic hormone [Online exclusive]. Oncology Nursing Forum, 30, E36E68. Fojo, A.T. (2005). Metabolic emergencies. In V.T. DeVita, S. Hellman, & S.A. Rosenberg (Eds.), Cancer: Principles and practice of oncology (7th ed., pp. 22922300). Philadelphia, PA: Lippincott Williams and Wilkins. Gobel, B.H. (2005). Metabolic emergencies. In J.K. Itano & K.N. Taoka (Eds.), Core curriculum for oncology nursing (4th ed., pp. 383421). St. Louis, MO: Elsevier Saunders. Keenan, A.K. (2005). Syndrome of inappropriate antidiuretic hormone. In C.H. Yarbro, M.H. Frogge, & M. Goodman (Eds.), Cancer nursing: Principles and practice (6th ed., pp. 940945). Sudbury, MA: Jones and Bartlett.

  18. References (cont.) Langfeldt, L.A. (2003). Syndrome of inappropriate antidiuretic hormone secretion in malignancy: Review and implications for nursing management. Clinical Journal of Oncology Nursing, 7, 425430. Moore, J.M. (1998). Syndrome of inappropriate antidiuretic hormone. In B.L. Johnson & J. Gross (Eds.), Handbook of oncology nursing (3rd ed., pp. 711721). Sudbury, MA: Jones and Bartlett. Richerson, M.T. (2004). Electrolyte imbalances. In C.H. Yarbro, M.H. Frogge, & M. Goodman (Eds.), Cancer symptom management (3rd ed., pp. 440453). Sudbury, MA: Jones and Bartlett. Terpstra, T.L., & Terpstra, T.L. (2000). Syndrome of inappropriate antiduiretic hormone secretion: Recognition and management. MEDSURG Nursing, 9, 6168.

More Related