nurs 426 siadh power point
TRANSCRIPT
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
By Elyse NavarroNur 426
Nov. 2, 2011Glenda Tali
OVERVIEW o Case Study
o Description of Disease/Disorder
o Pathophysiology
o Clinical manifestations
o Diagnostic Tests
o Risk Factors
o Health Promotions
o Resources
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CASE STUDY A 66-year-old man presents to ER with symptoms of confusion, unsteadiness and headaches.
Previous history of psoriasis and frequent respiratory tract infections (two to three per year), which often required antibiotic treatment, but for which no formal diagnosis had been made.
He had a 30 pack year smoking history. He did not use medication. Based on his symptoms, his general practitioner suspected a brain tumor or early-onset dementia. His blood pressure was 126/80 lying and 130/84 standing, with a regular pulse of 88 bpm. He had no edema and his jugular venous pressure was normal.
Further physical examination was unremarkable.
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Van Der Lubbe, N., Thompson, C., Zietse, R., and Hoorn, E., The clinical challenge of SIADH—three cases NDT Plus (2009)
ANTIDIURETIC HORMONE (ADH) (ADH) SIADH
ANTIDIURETIC HORMONE (ADH)
SIADHADH FEEDBACK
SYSTEM
DESCRIPTION
• Body secretes excessive ADH• Failure in neg feedback
mechanism• Can not regulate release and
inhibition of ADH
• Potentially life threatening• Prognosis
• Depends on underlying D/O• Response to treatment
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PATHOPHYSIOLOGYExcessive antidiuretic hormone secretion
Increased renal tubule permeability
Increased water retention & expanded extracellular fluid volume
Reduced Plasma
osmolality
IntracellularFluid shift
Cerebraledema
Dilutionalhyponatremia
Diminishedaldosterone
secretion
Decreasedsodium
reabsorption in proximal
tubule
IncreasedSodium
excretion
Hyponatremia
Elevatedglomerular
filtration rate
SIADH
CLINICAL MANIFESTATIONS• CNS: weakness, lethargy, mental confusion, difficulty concentrating, restlessness, HA, seizures and coma
• GI: Congestion of GI tract & motility N/V, anorexia, muscle cramps, and bowel sounds
• CVS: Weight gain, Bp, elevated central venous & pulmonary artery occlusion pressure
• Pulmonary System: Fluid overload respirations, dyspnea, adventitious lung sounds, and frothy pink sputum
****Sx usually caused by hyponatremia & fluid retention
SIADHEarly signs and symptoms associated with mild to moderate hyponatremia : nausea, anorexia, thirst, weight gain, oliguria, weakness, fatigue, and muscle cramps.Usually become apparent when serum sodium falls to the115–120 mEq/l range.
DIAGNOSTIC TESTS SIADHo Diagnosis based on findings:o Hyponatremiao Decreased serum osmolarityo Euvolemia (hypotonic hyponatremia)o High urine specific gravityo Urine sodium more than 20 mEq/lo Urine osmolality greater than 1,400, normal or
decreased blood urea nitrogeno (BUN) and creatinine, hypouricemia, and
normal renal, adrenal, and thyroid function
Other potential causes of hyponatremia (e.g.,congestive heart failure, cirrhosis, adrenal insufficiency, Addison’s disease, and hypothyroidism) must be evaluated and ruled out during the diagnostic workup.
DIAGNOSTIC TESTSTest Normal
ResultAbnormalResult
Explanation
Urine osmolality
Blood osmolality
Serum sodium
Urine sodium
200–1200 mOsm/L
275–285 mOsm/L
136–145 mEq/L
20 mEq/L
>1200 mOsm/L
<275 mOsm/L
<120 mEq/L
>20 mEq/L
Excretion of inappropriately concentrated urine and hyponatremia caused by overproduction of ADH
Water loss in urine and hypernatremia lead to hemoconcentration; levels above 320 mOsm/L are considered “panic levels” and require immediate intervention
Sodium loss in the urine leads to hyponatremia and hemodilution
Sodium loss in the urine
Other Tests: Blood urea nitrogen, urine specific gravity, radioimmunoassay of ADH
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RISK FACTORS• Cancer – most common is small cell cancer of the lung• Meningitis, cerebral abscess, head injury, tumor• Pneumonia, TB, lung abscess• Porphyria, alcohol w/d• Drugs –opiates, chlorpropramide, carbamezapine, vincristine• Failure of vital organs: heart, lung, liver, and kidney• Surgery of nervous system
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HEALTH PROMOTION STRATEGIES Things you should do• Keep daily weight log• Limit the amount of fluids • Try drinking orange juice, tomato juice, or beef and chicken broth.• Do not stop your medication without first talking to your doctor • Stop smoking
Call your doctor • If the symptoms get worse, especially weight gain, low urine output, increased thirst, or personality changes• Uncontrolled pain
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RESOURCES
• Find-an-Endocrinologist:• www.hormone.org or call• 1-800-HORMONE (1-800-467-6663)
•The Hormone Foundation:• Pituitary Information:• www.hormone.org/pituitary/index.cfm
•Medline Plus: www.medlineplus.gov
•Pituitary Society: www.pituitarysociety.org
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REFERENCES
•Beddoe, A. (2011). Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). CINAHL Nursing Guide, Retrieved from EBSCOhost.
•Flounders, J. (2003). Syndrome of inappropriate antidiuretic hormone. Oncology Nursing Forum, 30(3), E63-7. Retrieved from EBSCOhost.•Langfeldt, L., & Cooley, M. (2003). Syndrome of inappropriate
antidiuretic hormones secretion in malignancy. Clinical Journal of Oncology Nursing, 7(4), 425-430.
doi:10.1188/03.CJON.425-430
REFERENCES
•Sole, M., Lamborn, M., & Hartshorn, J. (2001). Introduction to Critical Care Nursing (3rd ed.). Philadelphia, PA: W.B.
Saunders Company.•Sommers, M., Johnson, S., & Berry, T. (2007). Syndrome of Inappropriate Antidiuretic Hormone (SIADH). In , Diseases & Disorders: A Nursing Therapeutics Manual, 3rd ed Philadelphia, Pennsylvania: F.A. Davis Company. Retrieved from EBSCOhost.•Terpstra, T., & Terpstra, T. (2000). Syndrome of inappropriate antidiuretic hormone secretion: recognition and management. MEDSURG Nursing, 9(2), 61-70. Retrieved from EBSCOhost.•Van Der Lubbe, N., Thompson, C., Zietse, R., and Hoorn, E., The
clinical challenge of SIADH—three cases NDT Plus (2009) 2(suppl 3): iii20-iii24 doi:10.1093/ndtplus/sfp155
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