SIADH

Question 1

Posterior Pituitary - Syndrome of Inappropriate ADH (SIADH)

Answer 1

• Excess ADH
  > continues to be released when not needed
• Results in water retention, dilutional hyponatremia
  > edema, dcrd serum sodium lvls, & fluid overload
  > Sodium Is Always Down! (136-145mEq/L)
• Causes
  > cancer/cancer therapy
  > resp infections/impairment (pneum)
  > cns disorders (stroke, hemorrhage, infection, trauma)
  > drugs (SSRIs; -pine & -mide, NSAIDs, opioids)
  > neuro surgery

Question 2

Posterior Pituitary - Syndrome of Inappropriate ADH (SIADH): CMs

Answer 2

• Neuro impairment
• Sodium < 115mEq/L
  > confusion/ change in LOC
  > lethargy
  > headaches: can progress to dcrd responsiveness, seizures, coma
  > hostility
  > disorientatioon
• GI disturbances
  > loss of appetite
  > N/V

Question 3

Posterior Pituitary - Syndrome of Inappropriate ADH (SIADH): Treatment

Answer 3

• Treat cause
• Fluid restriction
  > 500-1000mL/24hrs
• Diuretics
• Hypertonic Saline (3%NaCl)
  > bring Na lvls up while brining fluid lvl down
  > alterations to Na lvls slowly
• Vasopressin receptor antagonists
  > Vaptans: Tolvatan or Conivaptan
• Provide safe envir’t, neuro checks q2-4

Question 4

Nursing Care for SIADH

Answer 4

• I&Os
  > incrd intake equal to output for DI
  > dcrd intake for SIADH; monitor for fluid overload
• Daily weights
  > concern if more than 2.2lb (1kg) in 1 day
• Blood chemistries
• Electrolytes
  > DI: sodium (high), plasma osmolarity (high)
  > SIADH: sodium (low)