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Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

Elise J. Barney, DO Reviewed 06/2020
 


BASICS

DESCRIPTION

  • A syndrome of abnormal production of antidiuretic hormone (ADH), despite low serum osmolality, leading to hyponatremia and inappropriately elevated urine osmolality

    • Decreased urinary ...

DIAGNOSIS

HISTORY

Symptoms: 
  • Fatigue

  • Anorexia

  • Nausea

  • Vomiting

  • Diarrhea

  • Headaches

  • Unsteady gait

  • Falls

  • Myalgias/weakness

  • Increased thirst

  • Confusion

  • Seizures, coma

PHYSICAL EXAM

  • Euvolemic state

  • Mild hyponatremia (serum ...

TREATMENT

GENERAL MEASURES

  • Treatment of the underlying cause is essential.

  • Requires frequent monitoring (see “Patient Monitoring”)

  • Fluid restriction (usually <1,000 mL/day) is the main treatment (2)[B...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Careful continuous clinical and laboratory monitoring of hyponatremic state during acute phase:

    • Hourly urine output

    • Urine Na, urine potassium, uri...

REFERENCES

1
Decaux G, Musch W. Clinical laboratory evaluation of the syndrome of inappropriate secretion of antidiuretic hormone. Clin J Am Soc Nephrol.  2008;3(4):1175–1184.
2
Ellison DH, Berl T. ...

ADDITIONAL READING

SEE ALSO

Hyponatremia 

CODES

ICD10

E22.2 Syndrome of inappropriate secretion of antidiuretic hormone 

ICD9

253.6 Other disorders of neurohypophysis 

SNOMED

55004003 Syndrome of inappropriate vasopressin secretion (disorder) 

CLINICAL PEARLS

  • Treatment of the underlying cause is a key. Review all medications for potential culprits.

  • Fluid restriction is the mainstay of treatment in SIADH. Fluid restriction fails to correct hy...

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