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Antidiuretic hormone
(SIADH)
MOHD ASRUL
MEDICAL DEPARTMENT
Syndrome Of inapropriate
Antidiuretic hormone (SIADH)
Hyponatremia and hypo-osmolality
(plasma) resulting from
inappropriate, continued secretion or
action of the hormone despite normal
or increased plasma volume, which
results in impaired water excretion
Anatomy
Vasopressin or antidiuretic hormone
produces at Posterior Pituitary gland
Act on the renal tubules to induce
water retention leading to
concentration of urine
Excessive or inapropriate production
of ADH predispose to hyponatreamia
reflecting water retention.
Physiology
Diagnosis
Concentrated urine (Na > 20 mmol/L
and osmolality >500 mosmol/kg) in
the presence of hyponatreamia
(plasma Na < 125 mmol/L or low
plasma osmolality (<260 mosmol/kg)
and the absence of hypovolemia
oedema or diuretics.
Hyponatraemia
Is patient dehydrated
yes
Is urinary Na >20 mm
ol/L
yes
No
Is the patient is
edematous
No
yes
Addisons dis
Diuretic excess
Osmolar diuresis
High urea and high
glucose
Diarrhoea
Vomiting
Burn
Heat exposure
Small bowel
obstruction
No
yes
Nephrotic syndrome
Cardiac failure
Liver cirrhosis
Renal failure
No
SIADH
Water overload
Severe
hypothyroidism
Glucocorticoid
insuficiency
Investigation
Renal profile
Urine osmolality
Plasma osmolality
Treatment
Restrict fluid intake less than the
sum of insensible water loss and
urinary output.
Consider salt+loop diuretics if severe
Vasopressin receptor antagonist
Vaptans
Eg. Conivaptan,
ADH antagonist Demeclocycline.
Reference
Oxford textbook of Medicine
Harrison Internal medicine
Oxford handbook of medicine