The Syndrome of Inappropriate Antidiuresis

Ellison, David H.; Berl, Tomás

doi:10.1056/nejmcp066837

Cited by 847 publications

(737 citation statements)

References 44 publications

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“…ADH leads to the reabsorption of water in the collecting duct and the creation of concentrated urine with a urine osmolality of >100 mOsm/kg. Therefore, when the ECF compartment is expanded by isotonic fluids in the presence of high circulating ADH, sodium is excreted in the urine and free water is retained, leading to hyponatremia [13,33].…”

Section: Fluid Tonicity and Hyponatremiamentioning

confidence: 99%

Perioperative fluid management and postoperative hyponatremia in children

Sutherland

2015

Pediatr Nephrol

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Intravenous (IV) fluids are used ubiquitously when children undergo surgical procedures. Until recently, Holliday and Segar's guidelines for calculating maintenance fluids dictated fluid management strategies in postoperative pediatric patients. An increased recognition of hospitalacquired hyponatremia and its associated morbidity has led to a critical re-examination of IV fluid management in this population. Postsurgical patients are at high risk of developing hyponatremia due to the presence of non-osmotic stimuli for antidiuretic hormone release. Recent studies have established that, as they are administered in current practice, hypotonic maintenance fluids are associated with increased rates of hyponatremia. The best available data demonstrate that administration of isotonic fluid reduces hyponatremic risk. In this review, we discuss the collective data available on the subject and offer guidelines for fluid management and therapeutic monitoring.

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Section: Fluid Tonicity and Hyponatremiamentioning

confidence: 99%

Perioperative fluid management and postoperative hyponatremia in children

Sutherland

2015

Pediatr Nephrol

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“…Alternatively, the urine/plasma electrolyte ratio (U/ P) using spot urine values for sodium and potassium should be calculated by the equation [13,14] .…”

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confidence: 99%

Treatment of Hyponatremia: What the Clinician Needs to Know

Elisaf

Liamis

2015

Journal of Nephrology Research

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have been recently reported [3,4] , several aspects of the proper management of these patients are not clear [5,6] . In this editorial some basic principles for the appropriate management of patients with decreased serum sodium levels are briefly summarized.1) It should be stressed that non hypotonic hyponatremia (with normal or increased Posm) should be carefully excluded by a meticulous medical history and the appropriate laboratory investigation. Consequently, the initial approach to the hyponatremic patient includes the determination of Posm (by an osmometer if it is available) as well as the exclusion of pseudohyponatremia (due to severe hypercholesterolemia, hypertriglyceridemia, and hyperproteinemia) or hypertonic hyponatremia [due to the presence of osmotic active agents, such as glucose (hyperglycemia) or the administration of mannitol or glycine] [2,7,8] . It is worth mentioning that in hyperglycemic individuals the corrected serum sodium levels should be calculated by increasing the measured serum sodium levels by 2.4 mEq/L for each 100mg/dl of glucose above normal [4,8] .2) A growing list of drugs, including thiazides, ecstacy and SSRIs, can cause hyponatremia, while endocrine causes of hyponatremia (mainly adrenal insufficiency) should be carefully and appropriately assessed [9,10] .3) Urine sodium in a random urine specimen is commonly used to differentiate between hypovolemia-induced hyponatremia (urine sodium <20 mEq/L) and the syndrome of inappropriate antidiuresis (SIADH, urine sodium >30 mEq/L). However, increased urine sodium levels (>30 mEq/L) can also be encountered in patients with extracellular volume contraction with renal or adrenal insufficiency, severe metabolic alkalosis, osmotic diuresis, as well as in those on thiazides [2,8] .4) In cases of hypovolemia-associated hyponatremia, 0.9% sodium chloride solution should be administered (with potassium chloride 10% if hypokalemia is also present). In this setting potassium anions should be taken into account in the calculation of the tonicity of the infused solutions. Interestingly, the infusate formula proposed by the Adrogue-Madias and verified by Liamis et al can reliably project the effect of gaining 1L of any infusate on the patient's serum sodium (ΔΝα + s) and thus can be used to calculate the rate of the administered 0.9% NaCl solution [2,11,12] . ABSTRACTHyponatremia due to different pathogenetic mechanisms is the most common electrolyte abnormality and is associated with increased morbidity and mortality. However, several aspects of the proper management of these patients are not clear. In this editorial a brief overview of the basic principles for the appropriate treatment of hyponatremia are summarized. EDITORIALHyponatremia (serum sodium <135mEq/L) is the most common electrolyte abnormality, is due to different pathophysiologic mechanisms, is associated with increased morbidity and mortality and its appropriate treatment is still a therapeutic challenge [1,2] . Even though clinical practice guidelines on the treatment of hyp...

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“…Hyponatraemia is the most commonly seen electrolyte disturbance both in hospital inpatients and in the community 1. There are numerous recognised causes of hyponatraemia, and extremes of volume status – such as dehydration or fluid overload – are common precipitants.…”

Section: Introductionmentioning

confidence: 99%

The diagnosis and management of inpatient hyponatraemia and SIADH

Grant

Ayuk

Bouloux

et al. 2015

Eur J Clin Investigation

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BackgroundHyponatraemia is a very common medical condition that is associated with multiple poor clinical outcomes and is often managed suboptimally because of inadequate assessment and investigation. Previously published guidelines for its management are often complex and impractical to follow in a hospital environment, where patients may present to divergent specialists, as well as to generalists.DesignA group of senior, experienced UK clinicians, met to develop a practical algorithm for the assessment and management of hyponatraemia in a hospital setting. The latest evidence was discussed and reviewed in the light of current clinical practicalities to ensure an up‐to‐date perspective. An algorithm was largely developed following consensus opinion, followed up with subsequent additions and amendments that were agreed by all authors during several rounds of review.ResultsWe present a practical algorithm which includes a breakdown of the best methods to evaluate volume status, simple assessments for the diagnosis of the various causes and a straightforward approach to treatment to minimise complexity and maximise patient safety.ConclusionThe algorithm we have developed reflects the best available evidence and extensive clinical experience and provides practical, useable guidance to improve patient care.

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The Syndrome of Inappropriate Antidiuresis

Cited by 847 publications

References 44 publications

Perioperative fluid management and postoperative hyponatremia in children

Perioperative fluid management and postoperative hyponatremia in children

Treatment of Hyponatremia: What the Clinician Needs to Know

The diagnosis and management of inpatient hyponatraemia and SIADH

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