Syndrome of inappropriate antidiuretic hormone medical therapy: Difference between revisions
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Treatment of syndrome of inappropriate antidiuretic hormone depends on the etiology. For immediate improvement, all patients with SIADH require sharp restriction of their daily water intake and depending on the sodium levels, 3%hypertonic saline,loop diuretics with normal saline may be used. In emergency settings,Vasopressin-2 receptor antagonists (aquaretics, such as conivaptan or tolvaptan) are used. The most definitive way to treat SIADH is to deal with the underlying problem itself. If SIADH produced by [[drug]]s, then the patient must stop taking the medicine. If some infection may be the cause, the patient needs to controlling them by some [[antibiotics]] or other anti-microbiological drugs. | Treatment of syndrome of inappropriate antidiuretic hormone depends on the etiology. For immediate improvement, all patients with SIADH require sharp restriction of their daily water intake and depending on the sodium levels, 3%hypertonic saline,loop diuretics with normal saline may be used. In emergency settings,Vasopressin-2 receptor antagonists (aquaretics, such as conivaptan or tolvaptan) are used. The most definitive way to treat SIADH is to deal with the underlying problem itself. If SIADH produced by [[drug]]s, then the patient must stop taking the medicine. If some infection may be the cause, the patient needs to controlling them by some [[antibiotics]] or other anti-microbiological drugs. | ||
== | ==Medical treatment of SIADH== | ||
Fluid restriction is the mainstay of therapy. In situations where the etiology is secondary to head trauma or sub-arachnoid hemorrhage caution should be maintained because they might be in a volume depleted state. | Fluid restriction is the mainstay of therapy. In situations where the etiology is secondary to head trauma or sub-arachnoid hemorrhage caution should be maintained because they might be in a volume depleted state. | ||
3% Hypertonic saline is sometimes used,if sodium level falls below 125meq/l or patient has worsening symptoms (such as altered mental status, confusion). | 3% Hypertonic saline is sometimes used,if sodium level falls below 125meq/l or patient has worsening symptoms (such as altered mental status, confusion). | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]
Overview
Treatment of syndrome of inappropriate antidiuretic hormone depends on the etiology. For immediate improvement, all patients with SIADH require sharp restriction of their daily water intake and depending on the sodium levels, 3%hypertonic saline,loop diuretics with normal saline may be used. In emergency settings,Vasopressin-2 receptor antagonists (aquaretics, such as conivaptan or tolvaptan) are used. The most definitive way to treat SIADH is to deal with the underlying problem itself. If SIADH produced by drugs, then the patient must stop taking the medicine. If some infection may be the cause, the patient needs to controlling them by some antibiotics or other anti-microbiological drugs.
Medical treatment of SIADH
Fluid restriction is the mainstay of therapy. In situations where the etiology is secondary to head trauma or sub-arachnoid hemorrhage caution should be maintained because they might be in a volume depleted state. 3% Hypertonic saline is sometimes used,if sodium level falls below 125meq/l or patient has worsening symptoms (such as altered mental status, confusion). Oral salt tablets with loop diuretics:These are given together, as loop diuretics enhance the efficacy of salt tablets by inhibiting the countercurrent concentrating mechanism by decreasing sodium chloride reabsorption in the thick ascending limb of loop of Henle. Vasopressin-2 receptor antagonists such as conivaptan or tolvaptan used in severe hyponatremia in emergency setting. But the use is limiteduse of V2 receptor antagonists is limited due to increased thirst, rapid correction of sodium and high cost.[1]
- ↑ Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS, Orlandi C (2006). "Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia". N. Engl. J. Med. 355 (20): 2099–112. doi:10.1056/NEJMoa065181. PMID 17105757.