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    SIADH and Reset Osmostat

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    saleema11
    This document discusses SIADH (syndrome of inappropriate antidiuretic hormone secretion) and reset osmostat, which is sometimes considered a variant of SIADH. It provides diagnostic criteria for SIADH, including hyponatremia, low effective serum osmolality, urine osmolality over 100 mOsm/kg, absence of other conditions, and failure to correct hyponatremia with saline. Treatment options are also outlined, including fluid restriction, medications, and hemodialysis. The reset osmostat is then defined as a condition where the kidney can concentrate and dilute urine normally but the threshold for ADH secretion is lowered, potentially causing hyponatremia. Diagnosing reset

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    SIADH and Reset Osmostat

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    saleema11
    454 views7 pages
    This document discusses SIADH (syndrome of inappropriate antidiuretic hormone secretion) and reset osmostat, which is sometimes considered a variant of SIADH. It provides diagnostic criteria for SIADH, including hyponatremia, low effective serum osmolality, urine osmolality over 100 mOsm/kg, absence of other conditions, and failure to correct hyponatremia with saline. Treatment options are also outlined, including fluid restriction, medications, and hemodialysis. The reset osmostat is then defined as a condition where the kidney can concentrate and dilute urine normally but the threshold for ADH secretion is lowered, potentially causing hyponatremia. Diagnosing reset

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    treatment diagnostic criteria of SIADH from latest guidelines

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    This document discusses SIADH (syndrome of inappropriate antidiuretic hormone secretion) and reset osmostat, which is sometimes considered a variant of SIADH. It provides diagnostic criteria for SIADH, including hyponatremia, low effective serum osmolality, urine osmolality over 100 mOsm/kg, absence of other conditions, and failure to correct hyponatremia with saline. Treatment options are also outlined, including fluid restriction, medications, and hemodialysis. The reset osmostat is then defined as a condition where the kidney can concentrate and dilute urine normally but the threshold for ADH secretion is lowered, potentially causing hyponatremia. Diagnosing reset

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    454 views7 pages

    SIADH and Reset Osmostat

    Uploaded by

    saleema11
    This document discusses SIADH (syndrome of inappropriate antidiuretic hormone secretion) and reset osmostat, which is sometimes considered a variant of SIADH. It provides diagnostic criteria for SIADH, including hyponatremia, low effective serum osmolality, urine osmolality over 100 mOsm/kg, absence of other conditions, and failure to correct hyponatremia with saline. Treatment options are also outlined, including fluid restriction, medications, and hemodialysis. The reset osmostat is then defined as a condition where the kidney can concentrate and dilute urine normally but the threshold for ADH secretion is lowered, potentially causing hyponatremia. Diagnosing reset

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 7

    SIADH and Reset

    Osmostat

    Diagnostic criteria of SIADH (adapted from [Ellison and Berl, 2007]).


    SIADH, syndrome of inappropriate antidiuretic hormone secr

    Diagnostic Criteria

    Hyponatremia < 135 mmol/liter together with decreased effective


    serum osmolality < 275 mOsm/kg
    Spontaneous urinary osmolality > 100 mOsm/kg
    Presence of a compatible clinical history, such as brain disorder,
    pulmonary disease, malignancy, typical drug
    Absence of edematous disease (cardiac failure, liver cirrhosis,
    nephrotic syndrome) and of plasma volume depletion (i.e. absence of
    pathologic orthostatic changes, low internal jugular venous pulses,
    dryness of axillae)
    Spontaneous urinary sodium concentration > 40 mmol/liter, unless
    taking diuretics or on a severe salt restriction
    Normal adrenal and thyroid function
    Plasma uric acid < 200 mol/liter; fractional urate excretion > 12%
    (normal 5%);
    plasma urea < 4.5 mmol/liter; plasma creatinine < 80 mol/liter
    Failure to correct hyponatremia by infusion of 0.9% NaCl

    Treatment of SIADH
    Indirect modalities
    Fluid restriction
    Treatment of underlying pathology
    Hypertonic saline
    Loop diuretics
    Urea
    Democlycline, lithium
    Hemodialysis
    Direct modalities
    Vaptan treatment

    Reset Osmostat
    The "reset osmostat" is a cause of hyponatremia, sometimes
    considered a variant of SIADH, in which the kidney retains its
    ability to appropriately concentrate and dilute the urine;
    however, the threshold for ADH secretion is reset downward.
    That is, instead of ADH being secreted with the serum
    osmolality increases beyond 280-285 mOsm/kg as in most
    individuals, it is secreted at a lower value.

    Diagnosing reset osmostat is a diagnosis of exclusion.


    Individuals must be euvolemic, and a thorough exclusion of
    other causes of euvolemic hyponatremia (e.g., hypothyroidism,
    cortisol deficiency, medications, etc) must take place.

    A key feature of reset osmostat is that individuals


    should be able to concentrate and dilute the urine
    appropriately.
    Thus, a water challenge should result in a dilute urine
    (e.g., less than 100 mOsm/kg) and a water deprivation
    test should result in a concentrated urine.
    Reset osmostat classically occurs in neurologic
    conditions such as epilepsy and paraplegia, in addition
    to pregnancy, malignancy, and malnutrition

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