Managing hyponatremia in patients with syndrome of inappropriate antidiuretic hormone secretion

Abstract

This review will address the management of hyponatremia caused by the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in hospitalized patients. To do so requires an understanding of the pathogenesis and diagnosis of SIADH, as well as currently available treatment options. The review will be structured as responses to a series of questions, followed by a presentation of an algorithm for determining the most appropriate treatments for individual patients with SIADH based on their presenting symptoms. Journal of Hospital Medicine 2010;5:S18-S26. V C 2010 Society of Hospital Medicine. Why is SIADH Important to Hospitalists?Disorders of body fluids, and particularly hyponatremia, are among the most commonly encountered problems in clinical medicine, affecting up to 30% of hospitalized patients. In a study of 303,577 laboratory samples collected from 120,137 patients, the prevalence of hyponatremia (serum [Na þ ] <135 mmol/L) on initial presentation to a healthcare provider was 28.2% among those treated in an acute hospital care setting, 21% among those treated in an ambulatory hospital care setting, and 7.2% in community care centers. 1 Numerous other studies have corroborated a high prevalence of hyponatremia in hospitalized patients, 2 which reflects the increased vulnerability of this patient population to disruptions of body fluid homeostasis. Recognizing the many possible causes of hyponatremia in hospitalized patients and implementing appropriate treatment strategies therefore are critical steps toward optimizing care and improving outcomes in hospitalized patients with hyponatremia.In addition to its frequency, hyponatremia is also important because it has been associated with worse clinical outcomes across the entire range of inpatient care, from the general hospital population to those treated in the intensive care unit (ICU). In a study of 4123 patients age 65 years or older who were admitted to a community hospital, 3.5% had clinically significant hyponatremia (serum [Na þ ] <130 mmol/L) at admission. Compared with nonhyponatremic patients, those with hyponatremia were twice as likely to die during their hospital stay (relative risk [RR], 1.95; P < 0.05). 3 In another study of 2188 patients admitted to a medical ICU over a 5-year period, 13.7% had hyponatremia. The overall rate of in-hospital mortality among all ICU patients was high at 37.7%. However, severe hyponatremia (serum [Na þ ] <125 mmol/L) more than doubled the risk of in-hospital mortality (RR, 2.10; P < 0.001). 4 In addition to the general hospital population, in virtually every disease ever studied, the presence of hyponatremia has been found to be an independent risk factor for increased mortality, from congestive heart failure to tuberculosis to liver failure. 2 What Causes Hyponatremia in Patients with SIADH?Hyponatremia can be caused by 1 of 2 potential disruptions in fluid balance: dilution from retained water, or depletion from electrolyte losses in excess of water. Dilutional hyponatremias are associated with either a ...

Urea for management of the syndrome of inappropriate secretion of ADH: A systematic review

“…If the underlying cause of SIADH cannot be corrected, the main alternatives include water restriction or correction of hyponatremia through salt intake or drug treatment with demeclocycline, lithium, urea, phenytoin, or vaptans. 6 Water restriction is the classical therapeutic option in SIADH management, but is associated to low compliance, and additional alternatives are therefore often required. 7 Oral or intravenous treatment with urea has been for years a known alternative for management of SIADH-induced hyponatremia, but it is not widely used in standard clinical practice because of the scarce evidence supporting its efficacy and safety in this group of patients.…”

Serbest Su Kli̇rensi̇, Hi̇ponatremi̇ Ve Uygunsuz Anti̇di̇üreti̇k Hormon Salinimi Sendromu

“…Tolvaptan ve sıvı kısıtlaması ile tedavinin devamı düşünülebilir Klinik stabilizasyon sonrası hemen tanısal değerlendirme çalışmaları başlatılmalıdır. [18][19][20] Bulantı, konfüzyon, dezoryantasyon gibi orta klinik semptomları olan olgularda Hipovoleminin %0.9 salin infüzyonu %3 saline ± furosemit, tolvaptan ile düzeltilir. Serum sodyum değişimi 0.5 mmol/L/saat geçmemelidir.…”

“…Altta yatan etiyolojinin tanısı hızlıca ortaya konmaya çalışılmalıdır. [18][19][20] Başağrısı, irritabilite, konsantrasyon zorluğu, depresyon gibi hafif semptomatik olan veya asemptomatik olan olguların tedavisinde sıvı kısıtlamasına gidilir. Sıvı kısıtlaması başarısız olursa, iyon bozuklukları gelişirse, serum sodium düzeyi <125 mmol/L ise, serum sodium düzeyinin hızlı düzeltilmesine ihtiyaç varsa (örneğin hasta taburculuğu, operasyon öncesi gibi nedenler), semptomların düzelmesi için terapatik deneme yapılmak istenirse ise tolvaptan kullanılabilir.…”

Hyponatriämie

“…Tab. 4; [44]): Während ein idiopathischer SiADH wahrscheinlich dauerhaft behandelt werden muss, reicht bei der Behandlung eines postoperativen SiADH, z. B. im Rahmen einer Hypophysenoperation, eine einmalige Tolvaptangabe aus.…”