Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Daniel Stairs, CRNA, MSN, MBA Excela Health School of Anesthesia

SIADH Results from abnormal production or sustained secretion of ADH Results from abnormal production or sustained secretion of ADH Associated with many clinical states, syndromes, drugs Associated with many clinical states, syndromes, drugs

SIADH Most frequent cause is cancer Most frequent cause is cancer Especially small cell or oat cell cancer of lung Especially small cell or oat cell cancer of lung Since SIADH can precede the diagnosis of a tumor, it should always be viewed as potential marker of underlying malignancy Since SIADH can precede the diagnosis of a tumor, it should always be viewed as potential marker of underlying malignancy

SIADH Some pulmonary conditions associated with SIADH include bacterial pneumonias, COPD, TB, lung abcesses Some pulmonary conditions associated with SIADH include bacterial pneumonias, COPD, TB, lung abcesses Malignancies of pancreas, duodenum, colon, lymphoid tissue, and thymus can also produce SIADH Malignancies of pancreas, duodenum, colon, lymphoid tissue, and thymus can also produce SIADH

SIADH Diuretic, most commonly thiazides, have been related to SIADH occurrence Diuretic, most commonly thiazides, have been related to SIADH occurrence Others: antineoplastic drugs (vincristine), tricyclic antidepressants, nicotine have all been associated with increased amounts of circulating ADH Others: antineoplastic drugs (vincristine), tricyclic antidepressants, nicotine have all been associated with increased amounts of circulating ADH

SIADH Treatment: Eliminate underlying cause Treatment: Eliminate underlying cause Surgery, radiotherapy, chemo, for malignancy induced Surgery, radiotherapy, chemo, for malignancy induced Fluid restrictions Fluid restrictions For pts with neurological symptoms of severe hyponatremia – use of a hypertonic sodium chloride solution For pts with neurological symptoms of severe hyponatremia – use of a hypertonic sodium chloride solution