syndrome inappropriate antidiuretic hormone

1. Syndrome of inappropriate antidiuretic
harmone
Presented by
Karana ram choudhary
MSc.(n) 1st year
College Of Nursing AIIMS
JODHPUR

2. Introduction-
• It is a condition of hyperfunctioning of the posterior
pituitary gland in which increased ADH released,
but not in response to the bodys need for it .
• The syndrome of inappropriate antidiuretic
hormone (SIADH) is the most frequent cause of
hyponatraemia in hospital in patients.
• Hyponatraemia is the commonest electrolyte
abnormality found in hospital inpatients, and is
associated with a greatly increased morbidity and
mortality.

3. Anatomy and physiology of pituitary gland
• It is also called the Master
gland because it produces
the hormones that control
other glands and many
body functions including
growth
• The normal adult pituitary
gland is a reddish-brown
colour bean shaped
gland.

4. types of pituatory gland
• Anterior pituitary gland- largest part of the pituitary it control
by prvocellular neuro secretary cell of hypothalamus
• Anterior pituitary secrete 7 type harmone
• Growth hormone /somatotropin
• Prolactin hormone/ Galactopoetic/lactogenesis/mamotrophic
• Thyroid stimulating harmone
• Adrenocorticotrophic harmone
• Gonadotrophins
• Luteinizing hormone (LH)
• Follicle-stimulating hormone (FSH)
• Melanocyte stimulating harmone
• Somatotrophic growth harmone stimulating harmone

5. Posterior pituitary gland /neurohypophysis
• it develops from neural crest.
• posterior pituitary does not synthesise any type of
hormone it only store and release oxytocin or ADH
harmone
• anti-diuretic harmone –
• also known as vasopresine /pitressine
• It Formed in the supraoptic nuclie of the hypothalamus.
Transported to the posterior lobe of the PituitaryGland
and stored and release by posterior pituatory
• ADH is destruct and excreate by liver and kidney

6. Function of ADH
• It helps in reabsorption of water (mostly of the
nephron PCT by passive process)so maintain
fluid balance
• It constrict the blood vessels so help in
increase Blood pressure
• It helps in release of one von Willebrand factor
so use in haemophilia
• It also helps in social behaviour and sexual
motivations and pair bonding

7. Regulation of Secretion
• ADH secretion depends upon the volume of
body fluid and the osmolarity of the body
fluids.
• 1. Decrease in the extracellular fluid (ECF)
volume
• 2.Increase in osmolar concentration in the ECF.

8. Defination of siadh
• It is a condition is characterised by increase the
ADH secreation result in hypervolaemia
oligourea and weight gain

9. Cause s
• IncreaseADH due to hypothalamus and posterior pituitary tumour
• excessive ADH therapy
• small cell lung carcinoma
• Malignancy often in lungs and pancreas
• Meningitis
• head injury
• Stroke
• subarachnoid haemorrhage
• Stress
• Drugs that may cause SIADH.
• Antidepressant agents (selective serotonin reuptake inhibitors, tricyclic
antidepressants)’
• Cyclophosphamide,Hydrochlorothiazide. Carbamazine, desmopresine

10. Pathophysiology of SIADH
Due to etiological factors (trouma, tumour of hypothalamus )
Inappropriate ADH Secretion
Increased water reabsorption from renal collecting ducts
Increased blood volume
Continued water reabsorption leads to production of highly
concentrated urine
Hyponatraemia, low plasma osmolarity

11. Clinical Manifestation
• Hypervolaemia
• oligo urea
• blood osmolarity decrease
• increase urine osmolality and specific gravity
• hypertension
• dyspnoea
• Jugular Vein distension
• Weight gain

12. Hyperkalaemia
cardiac disarrhythmia
Odema
Changes in level of consciousness and mental status
changes
Tachycardia
Anorexia nausea vomiting
Bounding pulse

13. Diagnostic evaluation
• History collection
• Present health history, onset, duration, acute or chronic, etc
• Past health history- Any malignancy, surgery, , pulmonary
disease, etc.
• Medication history- Chemotherapy, anti-depressants, diuretics,
• Increase urine specific gravity (1.005-1.030)
• Increase urine osmolality decrease blood osmolarity.
• Low blood urea nitrogen (BUN)
• Low creatinine
• Low uric acid
• MRI of brain to detect the tumour of the brain and lungs .
• increase serum ADH level(Normal 1-5 pg /ml)

14. Medical management
• Administer IV fluids usually normal saline (hypertonic
saline) as prescribed.
• monitor IV fluids carefully because of the risk for fluid
volume overload.
• Loop diuretics may be prescribed to promote diuresis,
but only if serum sodium is at least 125 mEg/L
• Example- frusomide, Hydroclorthiazide.
• Vasopressin antagonists may be prescribed to decrease
the renal response to ADH.
Tablet demoeocyclovin(antidote of ADH)

15. Nursing management
• Monitor vital signs and cardiac status and neurological status.
• Provide a safe environment, particularly for the client with changes in
level of consciousness or mental status.
• Monitor for signs of increased intracranialpressure.
• Implement seizure precautions.
• Elevate the head of the bed a maximum of 10 degrees to promote
venous return and decrease baroreceptor-induced ADH release.
• Monitor intake and output and obtain weight daily.
• Monitor fluid and electrolyte balance.
• Monitor serum and urine osmolality.
• Restrict fluid intake as prescribed.
• Symptomatic treatment of other disease like lungs cancer
• Give low potesium and balance sodium diet

16. Research article
• Management of SIADH-related hyponatremia due to
psychotropic medications - An expert consensus from the
Association of Medicine and Psychiatry
• Aaron Pinkhasov . J Psychosom . 2021 Dec
• Abstract
• Hyponatremia is the most common electrolyte imbalance
encountered in clinical practice and is associated with negative
healthcare outcomes and cost. SIADH is thought to account
for one third of all hyponatremia cases and is typically an
insidious process. Psychotropic medications are commonly
implicated in the etiology of drug induced SIADH. There is
limited guidance for clinicians on management of
psychotropic-induced SIADH.

17. Methods:
After an extensive review of the existing literature, clinical-
educators from the Association of Medicine and Psychiatry
developed expert consensus recommendations for management of
psychotropic-induced SIADH. A risk score was proposed based on
risk factors for SIADH to guide clinical decision-making
Results:
SSRIs, , antipsychotics, carbamazepine, and oxcarbazepine have
moderate to high level of evidence demonstrating their association
with SIADH. Evaluation for an avoidance of medications that cause
hyponatremia is particularly important. Substitution with medication
that is less likely to cause SIADH should be considered when
appropriate. We propose an algorithmic approach to monitoring
hyponatremia with SIADH and corresponding treatment depending
on symptom severity.

18. Summary
• In this seminar we discussed about the
introduction, definition, , etiology , risk
f a c t o r s , p a t h o p h y s i o l o g y, c l i n i c a l
manifestations, diagnosis, medical, surgical
and nursing management of Syndrome of
inappropriate antidiuretic harmone

19. CONCLUSION
• As discussed throughout the presentation,
learning about SIADH and its management
will help nurses to care for a SIADH patient.
Nurses can do assessment of SIADH patient,
observe the sign and symptoms, provide the
necessary nursing care and support the patient
psychologically. Nurses can also counsel the
patients and their family for various options
available in SIADH treatment.

20. Referances
• Lewis. Medical Surgical Nursing Assessment and Management of
clinical problems.2015. New Delhi. Elsevier. 2nd Edition. Volume I.
Pg. no. 1244-1246
• Brunner and Suddarth; Textbook of Medical Surgical Nursing 13th
Edition Volume I. New Delhi; Wolters Kluwer Publication,
• Harding, Kwong, Roberts, Hagler, Reinisch; Lewis’s Medical Surgical
Nursing 11th Edition Volume I. Philadelphia; Elsevier Publications
• Medscape. Syndrome of Inappropriate Antidiuretic Hormone Secretion
(SIADH).
• Available from https://emedicine.medscape.com/article/246650-
overview Icited30 aug
2019