Syndrome of Inappropriate ADH
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Questions and Answers

What is the primary cause of the fluid retention in SIADH?

  • Decreased glomerular filtration rate
  • Increased permeability of the renal distal tubule and collecting duct (correct)
  • Increased sodium levels in the blood
  • Decreased production of antidiuretic hormone (ADH)

    • What is the common effect of SIADH on serum sodium levels?

  • Sodium levels fluctuate significantly
  • Normal sodium levels
  • Hypernatremia
  • Hyponatremia (correct)

    • Which of the following is a clinical manifestation of SIADH that can occur with severe hyponatremia?

  • Increased urine output
  • Decreased body weight
  • Increased thirst
  • Muscle cramps (correct)

    • What is the most common cause of SIADH?

    <p>Cancer (C)</p> Signup and view all the answers

    Which of the following diagnostic tests is crucial for confirming a diagnosis of SIADH?

    <p>Simultaneous measurements of urine and serum osmolality (A)</p> Signup and view all the answers

    What is the typical characteristic of urine specific gravity in patients with SIADH?

    <p>Greater than 1.030 (B)</p> Signup and view all the answers

    What is the typical effect of SIADH on glomerular filtration rate?

    <p>Increased glomerular filtration rate (B)</p> Signup and view all the answers

    Which of the following conditions can be associated with a chronic form of SIADH?

    <p>Tumors (B)</p> Signup and view all the answers

    Which of the following symptoms may occur with SIADH?

    <p>Muscle weakness (A)</p> Signup and view all the answers

    What type of cancer is most commonly associated with SIADH?

    <p>Small cell lung cancer (A)</p> Signup and view all the answers

    Which of these medications is NOT listed as a potential cause of SIADH in the text?

    <p>Propranolol (D)</p> Signup and view all the answers

    What is the recommended fluid restriction for patients with mild SIADH?

    <p>800 to 1000 mL/day (A)</p> Signup and view all the answers

    Which of the following is NOT a potential complication of SIADH?

    <p>Hypoglycemia (A)</p> Signup and view all the answers

    Which type of diuretic is specifically mentioned as a potential treatment for SIADH?

    <p>Loop diuretics (B)</p> Signup and view all the answers

    In patients with SIADH, the use of loop diuretics may require the administration of which of the following?

    <p>Calcium and magnesium supplements (D)</p> Signup and view all the answers

    What is the recommended treatment for severe hyponatremia (sodium level less than 120 mEq/L) in the presence of neurologic manifestations?

    <p>IV hypertonic saline solution (A)</p> Signup and view all the answers

    What is the primary mechanism of action of demeclocycline in treating SIADH?

    <p>Blocks the effect of ADH on renal tubules (D)</p> Signup and view all the answers

    What is the recommended position for patients with SIADH?

    <p>Head of the bed flat (D)</p> Signup and view all the answers

    Which of the following is an orally administered vasopressor receptor antagonist used to treat SIADH?

    <p>Tolvaptan (B)</p> Signup and view all the answers

    Which of the following is NOT a recommended self-management strategy for chronic SIADH?

    <p>Increase caffeine intake to suppress thirst (D)</p> Signup and view all the answers

    Study Notes

    Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

    • Definition: SIADH results from excessive ADH production or release, despite normal or low plasma osmolarity. ADH increases kidney water reabsorption.

    • Pathophysiology: Increased ADH leads to fluid retention, decreased plasma osmolality, decreased sodium levels (dilutional hyponatremia), and concentrated urine.

    • Etiology: Most commonly caused by cancer (especially small cell lung cancer), head trauma, or medications. Can also be caused by other conditions like CNS disorders and metabolic diseases.

    Clinical Manifestations

    • Early symptoms: Thirst, dyspnea, fatigue, muscle cramps, irritability, headache.

    • Severe symptoms (lower sodium levels): Vomiting, abdominal cramps, muscle twitching, lethargy, confusion, seizures, coma, cerebral edema.

    Diagnosis

    • Diagnostic tests: Measurement of urine and serum osmolality. Key indicators include: serum sodium less than 135 mEq/L, serum osmolality less than 280 mOsm/kg, and urine specific gravity greater than 1.030.

    Treatment

    • Mild cases (serum sodium > 125 mEq/L): Fluid restriction of 800-1000 mL/day. Monitor for weight loss, and gradual rise in sodium and osmolality.

    • More severe cases (severe hyponatremia): Fluid restriction of 500 mL/day. Careful slow correction of sodium levels (no more than 8-12 mEq/L/day) with possible IV hypertonic saline to avoid osmotic demyelination.

    • Medications: Loop diuretics (like furosemide) can promote diuresis, but only if sodium levels are above 125mEq/L. Demeclocycline blocks ADH effects. Vasopressor receptor antagonists (conivaptan and tolvaptan) for hospitalized cases of euvolemic hyponatremia. Avoid these medications if liver disease is present

    • Important considerations: Seizure precautions for patients with altered sensorium or seizures, keep the patient's head slightly elevated when possible(under 10 degrees). Monitor fluid intake and output, vital signs, electrolytes to avoid further complications, frequent position changes.

    Chronic SIADH Management

    • Fluid restriction: 800-1000 mL/day. Offer ice chips or sugar-free gum to manage thirst.

    • Dietary supplements: Encourage dietary sodium and potassium.

    • Monitoring: Daily weights are crucial for assessing fluid balance. Teach patients symptoms of fluid and electrolyte imbalances impacting sodium and potassium levels.

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    Description

    This quiz covers the Syndrome of Inappropriate Antidiuretic Hormone (SIADH), including its definition, pathophysiology, etiology, and clinical manifestations. Test your knowledge on early and severe symptoms, as well as the diagnostic processes for SIADH.

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