Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Questions & Answers

Updated: Aug 16, 2019
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
  • Print
Questions & Answers

Overview

What is syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What should be considered in the medical history of suspected syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What physical findings of severe or rapid-onset hyponatremia may be seen in syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What is the Bartter-Schwartz criteria for confirming a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What lab tests may be helpful in the diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What imaging studies may be considered in patients with syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What should be considered prior to initiating treatment for syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

When is chronic syndrome of inappropriate antidiuretic hormone secretion (SIADH) presumed in patients?

How is syndrome of inappropriate antidiuretic hormone secretion (SIADH) treated in an emergency department (ED)?

What are the treatment options for syndrome of inappropriate antidiuretic hormone secretion (SIADH) in an acute setting?

What are treatment options for chronic asymptomatic syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What is the most common cause of euvolemic hyponatremia in hospitalized patients?

What is arginine vasopressin (AVP) hormone and how does it work?

How is arginine vasopressin (AVP) synthesized?

What are the major stimuli for arginine vasopressin (AVP) secretion?

Which receptors bind arginine vasopressin (AVP) at the cell membrane?

Where are V1a and V1b receptors found and what do they do?

Where are V2 receptors found and what do they do?

At what level of plasma osmolality does arginine vasopressin (AVP) secretion cease normally?

What causes arginine vasopressin (AVP) secretion?

What causes hyponatremia in syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What is the pathophysiology of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Can syndrome of inappropriate antidiuretic hormone secretion (SIADH) occur if water intake is restricted?

What causes increase of water ingestion in persons with syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What causes neurologic complications in syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

How are causes of syndrome of inappropriate antidiuretic hormone secretion (SIADH) categorized?

Which nervous system disorders are associated with syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Which neoplastic disorders are associated with syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Which pulmonary disorders are associated with syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Which drugs may induce syndrome of inappropriate antidiuretic hormone secretion (SIADH) by stimulating arginine vasopressin (AVP) release?

Which drugs may induce syndrome of inappropriate antidiuretic hormone secretion (SIADH) by potentiating the effects of arginine vasopressin (AVP) action?

Which drugs induce syndrome of inappropriate antidiuretic hormone secretion (SIADH) via an unknown mechanism?

What other drugs cause syndrome of inappropriate antidiuretic hormone secretion (SIADH) as an adverse effect?

What are miscellaneous causes of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What is the prevalence of syndrome of inappropriate antidiuretic hormone secretion (SIADH) in the US?

Is syndrome of inappropriate antidiuretic hormone secretion (SIADH) affect more common in men or women and is it more common in certain age groups?

What is the general prognosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What are complications of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Can mild hyponatremia cause significant physical impairment?

Presentation

What is the mortality rate of hyponatremia?

How is syndrome of inappropriate antidiuretic hormone secretion (SIADH) usually detected?

What are the important medical history considerations in syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

In patients with hyponatremia, what physical findings differentiate syndrome of inappropriate antidiuretic hormone secretion (SIADH) from other hyponatremic states?

DDX

What are the differential diagnoses of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What are differential diagnoses of syndrome of inappropriate antidiuretic hormone secretion (SIADH) in which renal water handling is impaired?

What are differential diagnoses of syndrome of inappropriate antidiuretic hormone secretion (SIADH) with normal water excretion?

What are the correction factors for the effect of plasma lipids on plasma Na+ concentration?

Why should Na+ levels be measured only in the aqueous phase?

How do elevated glucose levels affect serum Na+ levels?

What causes exercise-induced hyponatremia?

What is cerebral salt wasting (CSW)?

When should cerebral salt wasting (CSW) be considered in the differential diagnoses of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Which findings help differentiate cerebral salt wasting (CSW) from syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What are characteristics of cerebral salt wasting (CSW)?

What are mechanisms of cerebral salt wasting (CSW)?

How is cerebral salt wasting (CSW) treated?

What effect does cortisol have on antidiuretic hormone (ADH) and corticotropin-releasing hormone?

How does declining renal function affect hyponatremia?

Does a decreasing serum Na+ concentration during pregnancy require treatment?

How does water restriction affect hyponatremia?

How does hyponatremia develop in persons who do not have adequate food intake?

Do diuretics cause hyponatremia?

What is nephrogenic syndrome of inappropriate antidiuresis (NSIAD)?

What other conditions associated with hypervolemia should be considered in the differential diagnoses of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What are the differential diagnoses for Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?

Workup

What are the diagnostic criteria for syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

How is antidiuretic hormone secretion determined to be inappropriate when diagnosing syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What urine osmolality measurement confirms arginine vasopressin (AVP) excess?

What factors can modulate urine Na+ concentration in persons with syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What lab tests are helpful in the diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

In addition to hyponatremia, what other finding must be present in syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

How does syndrome of inappropriate antidiuretic hormone secretion (SIADH) affect serum bicarbonate levels?

How does syndrome of inappropriate antidiuretic hormone secretion (SIADH) affect serum potassium levels?

How does syndrome of inappropriate antidiuretic hormone secretion (SIADH) affect the anion gap?

How does syndrome of inappropriate antidiuretic hormone secretion (SIADH) affect urinary loss of Na+?

How does syndrome of inappropriate antidiuretic hormone secretion (SIADH) affect urine osmolality?

How does syndrome of inappropriate antidiuretic hormone secretion (SIADH) affect blood urea nitrogen (BUN) levels?

Can serum uric acid concentration be used to screen for syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

How does syndrome of inappropriate antidiuretic hormone secretion (SIADH) affect glomerular filtration rate (GFR)?

Is radioimmunoassay for antidiuretic hormone (ADH)/arginine vasopressin (AVP) useful in the diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

How can the presence of hypovolemia be ruled out in a clinical assessment of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What other causes of euvolemia should be excluded before a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is made?

What imaging studies may assist the diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Treatment

What factors are considered in treatment selection for syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What are the treatment guidelines for syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What is the risk of aggressive treatment of hyponatremia and when is it indicated?

What steps should be taken to reduce the risk of neurologic complications during the correction of serum Na+ levels in hyponatremia?

Is there a proven formula based on Na+ deficit for the dose and rate of administration of hypertonic saline?

Is furosemide used in the emergency department (ED) treatment of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

How is acute syndrome of inappropriate antidiuretic hormone secretion (SIADH) treated?

What is the role of water restriction in the treatment of acute syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What is the role of vasopressin receptor antagonists in the treatment of acute syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What is the role of furosemide in the treatment of acute syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

What is the treatment for asymptomatic chronic syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

When is urea used in the treatment of chronic syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

How is urea administered in chronic syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Medications

What medications are used in the treatment of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

Which medications in the drug class Vasopressin-Related are used in the treatment of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?

Which medications in the drug class Diuretics, Loop are used in the treatment of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?

Which medications in the drug class Diuretics, Osmotic Agents are used in the treatment of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?

Which medications in the drug class Tetracyclines are used in the treatment of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?