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Cerebro perdedor de sal & Liberación inadecuada hormona antidiuretica

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cerebro perdedor de sal & liberacion inadecuada hormona antidiuretica

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Cerebro perdedor de sal & Liberación inadecuada hormona antidiuretica

  1. 1. Síndrome de Liberación Inadecuada de ADH VS Cerebro Perdedor de Sal Alejandro Lindarte, MD Residente Farmacología Clínica Universidad de la Sabana
  2. 2. SIADH AUMENTO INADECUADO SECRECION ADH SNC: INFECCIONES, TRAUMA, TUMORES, HIDROCEFALIA , NEUROCX FARMACOS:QUIMIOTERAPIA (VINCRISTINA, CICLOFOSFAMIDA ), DIURETICOS PULMONAR : NEOPLASIAS, NEUMONIA, ASMA ,ATELECTASIA, TOSFERINA. HEREDITARIA (MUTACIONES RC V2)
  3. 3. ADH Aumenta Reabsorción De agua en TC AUMENTO MEC SRAA /PNA Retención Hídrica Hipervolemia Eliminación de Sodio Hiponatremia Aumento Osmolaridad Urinaria
  4. 4. SOSPECHARLA PACIENTES CON HIPONATREMIA EUVOLEMICA O HIPERVOLEMICA CLINICA : ANOREXIA DEBILIDAD NAUSEA DECAIMIENTO ESTUPOR COMA CONVULSIONES
  5. 5. DIAGNOSTICO HIPONATREMIA < 130 MEQ/LT HIPOOSMOLARIDAD < 270 MOSM/LT NATRIURESIS > 60 MEQ /LT OSM URINARIA >300>500 MOSM/L R. OSMu/OSMpls >1 GU < 1 ML/KG/HR VOLEMIA NORMAL O AUMENTADA ADH Y ALD AUMENTADA
  6. 6. 11/1000 INTERVENCIONES NEUROQX
  7. 7. 1950 PETERS HIPONATREMIA DEPLECION VOLUMEN EC PERDIDA URINARIA DE SODIO EN PACIENTES CON DAÑO CEREBRAL 1° 48 HR 10 DIAS
  8. 8. HSA NEUROQX CARCINOMATOSIS MENINGITIS/ENCEFALITIS TUMORES SNC CAUSAS
  9. 9. FISIOPATOLOGIA
  10. 10. Disminución tono simpático Inactiva sistema renina TEORIAS DE FISIOPATOLOGIA Baja Aldosterona Disminución de la reabsorción de sodio y agua Baja Angiotensina ll 1.Afeccion directa del del tono simpatico
  11. 11. TEORIAS DE FISIOPATOLOGIA 2. Peptido Natriuretico
  12. 12. HSA Producción OLC Bloqueo de la NaKATPasa Disminuye el Intercambio NA – K de la reabsorción Compuesto similar Ouabaina (similar a digoxina) TEORIAS DE FISIOPATOLOGIA
  13. 13. Correlación
  14. 14. DIAGNOSTICO DEPLECION VOL EC DHT POLIURIA >4 ML KG HIPONATREMIA < 130 MEQ /LT HIPOOSMOLARIDAD PLASMATICA AUMENTO OSM URINARIA > 100 -300 MOSM BALANCE NEGATIVO DE SODIO ALTO SODIO ORINA >120 MEQ /LT
  15. 15. DX DIFERENCIAL SIADH AMBOS HIPONATREMIA AMBOS NATRIURESIS (MAYOR LA CPS) AMBOS DENSIDAD URINARIA ALTA AMBOS HIPOSMOLARIDAD PLASMA CPS: HIPOVOLEMIA /DHT CPS : POLIURIA SIADH : OLIGURIA , NORMOVOLEMIA
  16. 16. COMPLICACIONES ENCEFALOPATIA HIPONATREMICA SHOCK HIPOVOLEMICO PARO RESPIRATORIO SSN /SS3% LENTO CORRECCION HIPONATREMIA FLUOROCORTISONA 0.2- 0.4 MG/Día: MINERALOCORTICOIDE ACTUA TUBULO RENAL AUMENTA REABSORCION SODIO
  17. 17. SIADH CPS Volumen plasmático Aumentado Disminuido Hipovolemia/deshidratación NO SI Osmolaridad sérica (mOsm/K)  270  270 Osmolaridad urinaria (mOsm/K)  500  300 R. Osm urinaria / osm plasmática >1 >1 Densidad urinaria  1020 1010 Diuresis (ml/K/h) < 1 > 3 Sodio plasmático (mmol/L)  130 130 Sodio urinario (mmol/L)  60 120 ADH plasmática Aumentada Normal o leve baja

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