Syndrome of Inappropriate Syndrome of Inappropriate Antidiuretic HormoneAntidiuretic Hormone

(SIADH)(SIADH)

Daniel Stairs, CRNA, MSN, MBADaniel Stairs, CRNA, MSN, MBA

Excela Health School of AnesthesiaExcela Health School of Anesthesia

SIADHSIADH

Results from abnormal Results from abnormal production or sustained production or sustained secretion of ADHsecretion of ADH

Associated with many Associated with many clinical states, clinical states, syndromes, drugssyndromes, drugs

SIADHSIADH

Most frequent cause is cancerMost frequent cause is cancer Especially small cell or oat cell Especially small cell or oat cell

cancer of lungcancer of lung Since SIADH can precede the Since SIADH can precede the

diagnosis of a tumor, it should diagnosis of a tumor, it should always be viewed as potential always be viewed as potential marker of underlying malignancymarker of underlying malignancy

SIADHSIADH

Some pulmonary conditions Some pulmonary conditions associated with SIADH include associated with SIADH include bacterial pneumonias, COPD, TB, bacterial pneumonias, COPD, TB, lung abcesseslung abcesses

Malignancies of pancreas, Malignancies of pancreas, duodenum, colon, lymphoid duodenum, colon, lymphoid tissue, and thymus can also tissue, and thymus can also produce SIADHproduce SIADH

SIADHSIADH

Diuretic, most commonly Diuretic, most commonly thiazides, have been related to thiazides, have been related to SIADH occurrenceSIADH occurrence

Others: antineoplastic drugs Others: antineoplastic drugs (vincristine), tricyclic (vincristine), tricyclic antidepressants, nicotine have all antidepressants, nicotine have all been associated with increased been associated with increased amounts of circulating ADHamounts of circulating ADH

SIADHSIADH

Treatment: Eliminate underlying causeTreatment: Eliminate underlying cause Surgery, radiotherapy, chemo, for Surgery, radiotherapy, chemo, for

malignancy inducedmalignancy induced Fluid restrictionsFluid restrictions For pts with neurological symptoms of For pts with neurological symptoms of

severe hyponatremia – use of a severe hyponatremia – use of a hypertonic sodium chloride solutionhypertonic sodium chloride solution