NURS 3664 Lecture Notes - Lecture 22: Syndrome Of Inappropriate Antidiuretic Hormone Secretion, Loop Diuretic, Posterior Pituitary
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Syndrome of inappropriate antidiuretic hormone (siadh) and diabetes insipidus (di) Hormones secreted: antidiuretic hormone (adh) (also called vasopressin) and oxytocin. Adh regulator of water balance and serum osmolality. Drugs vasopressin, thiazide-like diuretics, nsaids, antidepressants, antipsychotics. Na < 120 mmol/l vomiting, abdominal cramps, muscle twitching, lethargy, confusion, seizures, coma. Stop / avoid medications that stimulate adh (table 49-2) Fluid restriction 800- 1000 ml daily (mild - na > 125 meq/l) Loop diuretic - na at >125 meq/l k, mg, ca supplements. Iv hypertonic saline (3%) slowly given! Vasopressor receptor antagonists conivaptan(vapriosol) & tolvaptan(samsca) Monitor i&o - low urine output with high specific gravity. Daily weights - sudden weight gain without edema. Seizure precautions & hourly neuro checks na level < 120 mg/dl. Bed flat or no greater 10 degrees (enhance venous return) Deficiency in production or secretion of adh. Damage to pituitary gland or hypothalamus (surgery, tumor, illness / meningitis, head injury. Defect kidney tubules - genetic, medications (lithium)
