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Friday, January 31, 2014

Syndrome of inappropriate anti-diuretic hormone SIADH its causes and newest treatment

It means an excessive release of ADH
1. Physiology :
Refer to diabetes insipidus.
2. Etiology :
a. Tumor oat cell carcinoma.
b. Pulmonary lesion :Legionella pneumonia , T.B.
c. CNS : meningitis, encephalitis & head injuries.
d. Drugs :
cholropropamide,carbamazepine,cyclophosphamide -
3. C / P :
· Increased ADH causes water retentionwater
intoxication dilutional hyponatremia ( nausea,
vomiting, confusion, headache, convulsions &
coma.)
· No edema because of natriuresis.
4. Investigation :
1. Na (< 130m.Eq /L )
2. serum osmolarity(< 270m.osmol/L.) & urine
osmolarity ( > 300 m.osmol/L.)
N.B. : Normal renal , adrenal & thyroid functions.
5. Treatment :
a. Fluid restriction 800-1000 ml / day.
b. demeclocycline:
i. 600-1200 mg /day inhibit i action of ADH.
ii. Given to patient unresponsive to fluid restriction.
c. For sever hyponatremia : hypertonic saline 1.8% slowly é
fursemide to treat hyponatremia

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