Excessive ADH secretion causes water retention, leading to dilutional hyponatremia and fluid overload.

Common causes: Malignancy (lung cancer), CNS disorders (stroke), pulmonary disease, certain medications.

Characterized by Hyponatremia (low serum sodium). Neurologic symptoms worsen below 120 mEq/L.

Low serum osmolality (<275 mOsm/kg) because excess water dilutes solute concentration in blood.

Inappropriately HIGH urine osmolality (>100 mOsm/kg) as kidneys concentrate urine despite low serum levels.

High urine sodium (>20 mEq/L) due to expanded blood volume inhibiting renal sodium reabsorption.

Elevated (>1.030) because kidneys are concentrating urine under the influence of excessive ADH.

"Soaked Inside": Weight gain without edema, normal/high BP, bounding pulses, crackles, JVD.

From cerebral edema: Headache, confusion, irritability, muscle cramps, seizures, coma.

Fluid Restriction (500-1000 mL per 24 hours). This is the first-line intervention.

Daily weights are crucial. A gain of 1 kg (2.2 lbs) indicates 1 liter of fluid retention.

Tetracycline antibiotic that induces nephrogenic DI to promote water excretion. Causes photosensitivity.

Oral vasopressin receptor antagonist (aquaretic). Causes free water excretion. Black Box: Do NOT fluid restrict with it.

Severe Symptom Treatment

3% Hypertonic Saline for severe hyponatremia with neuro symptoms. Must be administered VERY slowly.

Complication - Osmotic Demyelination

Irreversible brain damage from correcting sodium too quickly. Symptoms: dysarthria, mutism, paralysis.

Provide ice chips, frequent oral rinses (but don't swallow) to manage thirst during fluid restriction.

Hemoglobin and Hematocrit are decreased due to hemodilution (too much plasma volume).

In hypovolemia, the body conserves both sodium and water. In SIADH, it wastes sodium while keeping water.

Implement for patients with severe hyponatremia. Ensure a safe environment and have airway equipment ready.

Adherence to fluid restriction, recognizing signs of worsening fluid overload or hyponatremia.

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SIADH

Question	Answer
Core Problem	Excessive ADH secretion causes water retention, leading to dilutional hyponatremia and fluid overload.
Key Etiologies	Common causes: Malignancy (lung cancer), CNS disorders (stroke), pulmonary disease, certain medications.
Serum Sodium Level	Characterized by Hyponatremia (low serum sodium). Neurologic symptoms worsen below 120 mEq/L.
Osmolality	Low serum osmolality (<275 mOsm/kg) because excess water dilutes solute concentration in blood.
Osmolality	Inappropriately HIGH urine osmolality (>100 mOsm/kg) as kidneys concentrate urine despite low serum levels.
Sodium Level	High urine sodium (>20 mEq/L) due to expanded blood volume inhibiting renal sodium reabsorption.
Specific Gravity	Elevated (>1.030) because kidneys are concentrating urine under the influence of excessive ADH.
Classic Presentation	"Soaked Inside": Weight gain without edema, normal/high BP, bounding pulses, crackles, JVD.
Neurologic Symptoms	From cerebral edema: Headache, confusion, irritability, muscle cramps, seizures, coma.
Primary Treatment	Fluid Restriction (500-1000 mL per 24 hours). This is the first-line intervention.
Daily Monitoring	Daily weights are crucial. A gain of 1 kg (2.2 lbs) indicates 1 liter of fluid retention.
Demeclocycline	Tetracycline antibiotic that induces nephrogenic DI to promote water excretion. Causes photosensitivity.
Tolvaptan	Oral vasopressin receptor antagonist (aquaretic). Causes free water excretion. Black Box: Do NOT fluid restrict with it.
Severe Symptom Treatment	3% Hypertonic Saline for severe hyponatremia with neuro symptoms. Must be administered VERY slowly.
Complication - Osmotic Demyelination	Irreversible brain damage from correcting sodium too quickly. Symptoms: dysarthria, mutism, paralysis.
Mouth Care	Provide ice chips, frequent oral rinses (but don't swallow) to manage thirst during fluid restriction.
H&H	Hemoglobin and Hematocrit are decreased due to hemodilution (too much plasma volume).
Not Hypovolemia	In hypovolemia, the body conserves both sodium and water. In SIADH, it wastes sodium while keeping water.
Seizure Precautions	Implement for patients with severe hyponatremia. Ensure a safe environment and have airway equipment ready.
Patient Teaching	Adherence to fluid restriction, recognizing signs of worsening fluid overload or hyponatremia.

Created by: Wasurenboh

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