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SIADH

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Vishal Golay
Vishal Golay
Saúde e medicina
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SIADH SYNDROME OF INAPPROPRIATE SECRETION OF ANTI DIURETIC HORMONE 22.12.10
Outline Of The Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object]
Prevalance of hyponatremia ,[object Object],[object Object],Sajadieh A.AJEM 2009 122 679–686 . Gankam Kengne F.QJOM 2008 101 583–588
[object Object],[object Object],Zilberberg MD BMC Pulmonary Medicine 2008 8 16. Sherlock M Endocrinology 2006 64 250–254
ADH: AntiDiuretic Hormone ,[object Object],[object Object],[object Object]
 
Function of ADH ,[object Object],[object Object],[object Object],[object Object]
[object Object]
Syndrome of Inappropriate AntiDiuretic Hormone ,[object Object],[object Object]
…… .SIADH……. ,[object Object],[object Object],[object Object]
Cardiac failure or cirrhosis on diuretic therapy Cirrhosis Cardiac failure Nephrotic syndrome Peripheral oedema Ascites Raised JVP Pulmonary oedema Underlying illness Hypervolaemic SIADH ACTH deficiency Hypothyroidism SIADH with ongoing fluid restriction Primary polydipsia Inappropriate fluid replacement Underlying illness Euvolaemic Diuretics Addison's disease Cerebral salt wasting Salt wasting nephropathy GI losses, Mucosal losses, Pancreatitis Sodium depletion post diuretics Dry mucous membranes, Decreased turgor, Tachycardia, Hypotension (orthostatic), Raised urea, rennin Hypovolaemic Urinary Na+>40 mmol/l Urinary Na+<20 mmol/l Clinical signs
[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],M J Hannon. European Journal of Endocrinology,2010. Vol 162
Causes of SIADH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of SIADH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Classification of SIADH ,[object Object],[object Object],Zerbe R Annual Review of Medicine 1980 31 315–327
Type A SIADH ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Type B SIADH ,[object Object],[object Object],[object Object],[object Object]
Type C SIADH ,[object Object],[object Object],[object Object]
Type D SIADH ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Copyright ©2010 European Society of Endocrinology Eur J Endocrinol. 2010 Jun;162(Suppl1):S5-S12 Figure 1 Summary of the four different patterns of AVP secretion in SIADH
CLINICAL FEATURES ,[object Object],[object Object],[object Object]
CLINICAL FEATURES ,[object Object],[object Object],[object Object]
Laboratory Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Table 1 Diagnostic criteria for SIADH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TREATMENT ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Isotonic saline ,[object Object],[object Object],[object Object]
Hypertonic saline ,[object Object],[object Object]
The Adrogué–Madias formula ,[object Object],[object Object]
Simple Rule Of Thumb ,[object Object],[object Object]
Demeclocycline ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Lithium ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Urea ,[object Object],[object Object],[object Object],[object Object],[object Object]
Extracorporeal treatments ,[object Object],[object Object],[object Object]
The vaptans ,[object Object],[object Object],[object Object],[object Object],[object Object]
V2 receptor antagonists in the treatment of SIADH. ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
How should treatment be monitored? ,[object Object],[object Object],[object Object]
SUMMARY ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
THANK YOU

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SIADH

  • 1. SIADH SYNDROME OF INAPPROPRIATE SECRETION OF ANTI DIURETIC HORMONE 22.12.10
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  • 12. Cardiac failure or cirrhosis on diuretic therapy Cirrhosis Cardiac failure Nephrotic syndrome Peripheral oedema Ascites Raised JVP Pulmonary oedema Underlying illness Hypervolaemic SIADH ACTH deficiency Hypothyroidism SIADH with ongoing fluid restriction Primary polydipsia Inappropriate fluid replacement Underlying illness Euvolaemic Diuretics Addison's disease Cerebral salt wasting Salt wasting nephropathy GI losses, Mucosal losses, Pancreatitis Sodium depletion post diuretics Dry mucous membranes, Decreased turgor, Tachycardia, Hypotension (orthostatic), Raised urea, rennin Hypovolaemic Urinary Na+>40 mmol/l Urinary Na+<20 mmol/l Clinical signs
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  • 27. Copyright ©2010 European Society of Endocrinology Eur J Endocrinol. 2010 Jun;162(Suppl1):S5-S12 Figure 1 Summary of the four different patterns of AVP secretion in SIADH
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