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This document discusses the syndrome of inappropriate antidiuretic hormone (SIADH). It begins by defining SIADH as a condition where the posterior pituitary gland releases too much antidiuretic hormone, leading to hyponatremia. It then covers the anatomy and functions of the pituitary gland and ADH, risk factors for SIADH, pathophysiology, clinical manifestations, diagnosis, and treatment approaches including medical management and nursing care. The presentation concludes that learning about SIADH will help nurses properly assess, observe signs/symptoms, provide care, counsel patients, and support patients and their families.
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SIADS.pdf
- 1. Syndrome of inappropriateantidiuretic harmone Presented by Karana ram choudhary MSc.(n) 1st year College Of Nursing AIIMS JODHPUR
- 2. Introduction- • It isa 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 physiologyof 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 pituatorygland • 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 • IncreaseADHdue 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 Dueto 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 inlevel of consciousness and mental status changes Tachycardia Anorexia nausea vomiting Bounding pulse
- 13. Diagnostic evaluation • Historycollection • 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 • AdministerIV 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 • Monitorvital 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 • Managementof 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 extensivereview 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 thisseminar 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 discussedthroughout 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. MedicalSurgical 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