Pediatric Syndrome of Inappropriate Antidiuretic Hormone Secretion Follow-up

  • Author: Robert J Ferry Jr, MD; Chief Editor: Stephen Kemp, MD, PhD   more...
 
Updated: Apr 29, 2010
 

Further Inpatient Care

Closely monitor serum and urine electrolytes in patients with syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Reassess the patient's status frequently and readjust therapy as necessary.

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Further Outpatient Care

Restrict fluid to 1000 mL/m2/d.

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Inpatient & Outpatient Medications

The use of lithium carbonate should be considered in children with chronic syndrome of inappropriate antidiuretic hormone secretion. Demeclocycline can be used in children older than 8 years with chronic syndrome of inappropriate antidiuretic hormone secretion.

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Complications

The following complications are noted:

  • Fluid overload
    • Pulmonary edema
    • Hypertension
    • Anasarca
  • Acute extracellular hypoosmolality
  • Cerebral edema (may be observed at rates of plasma osmolality decrease faster than 10 mOsm/kg/h)
  • Permanent brain damage
  • Cerebral herniation (has been observed in postmortem examination in both humans and experimental animals)
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Prognosis

Prompt recovery usually follows water restriction. Prognosis of syndrome of inappropriate antidiuretic hormone secretion is usually that of the underlying disease.

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Patient Education

Stress the importance of fluid restriction in maintaining reference range serum sodium levels.

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Contributor Information and Disclosures
Author

Robert J Ferry Jr, MD  Le Bonheur Chair of Excellence in Endocrinology, Professor and Chief, Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, University of Tennessee Health Science Center; Deputy Commander for Clinical Services, Texas Medical Command, Army National Guard

Robert J Ferry Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, and Texas Pediatric Society

Disclosure: Nutropin Speakers Bureau Honoraria Speaking and teaching; Genotropin Speakers Bureau Honoraria Speaking and teaching; Eli Lilly & Co. Grant/research funds Investigator; MacroGenics, Inc. Grant/research funds Investigator; Ipsen, S.A. (formerly Tercica, Inc.) Grant/research funds Investigator; NovoNordisk SA Grant/research funds Investigator; Diamyd Investigator

Coauthor(s)

Jose F Pascual-y-Baralt, MD  Chief, Division of Pediatric Nephrology, San Antonio Military Pediatric Center; Clinical Professor, Department of Pediatrics, University of Texas Health Science Campus

Jose F Pascual-y-Baralt, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, American Society of Pediatric Nephrology, Association of Military Surgeons of the US, and International Society of Nephrology

Disclosure: Nothing to disclose.

Specialty Editor Board

Arlan L Rosenbloom, MD  Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida College of Medicine; Fellow of the American Academy of Pediatrics; Fellow of the American College of Epidemiology

Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Florida Pediatric Society, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Lynne Lipton Levitsky, MD  Chief, Pediatric Endocrine Unit, Massachusetts General Hospital; Associate Professor of Pediatrics, Harvard Medical School

Lynne Lipton Levitsky, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Diabetes Association, American Pediatric Society, Endocrine Society, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Pfizer Grant/research funds P.I.; Tercica Grant/research funds Other; Eli Lily Grant/research funds PI; NovoNordisk Grant/research funds PI

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD  Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital

Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

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Disorders associated with syndrome of inappropriate secretion of antidiuretic hormone (SIADH).
Drugs that impair water excretion.
Cerebral salt-wasting syndrome (CSWS) versus syndrome of inappropriate secretion of antidiuretic hormone (SIADH).
 
 
 
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