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Syndrome of Inappropriate

Antidiuretic Hormone

Reported By
Jo jo Ale
Syndr ome of Ina ppr opri ate
An tidi ur etic H or mone (SI ADH )

 Definition:
 Is an abnormal condition characterized by
excessive release of antidiuretic hormone
(ADH) that alters the body’s fluid and
electrolyte balances.
 Complications:
 Heart failure R/T fluid overload
 Cerebral edema secondary to water
intoxication from fluid retention
 Causes / Etiology / Risk  Use of (iatrogenics): –
Factors: Barbiturates,
 Lung tumor; head injury; anesthetics, thiazide
pituitary surgery; diuretics –
pancreatic & prostatic Chlorpropamide,
cancer; Hodgkin’s vincristine,
disease; pulmonary cyclophosphamide,
disease; viral/bacterial clofibrate,
COPD; bronchogenic metoclopramide,
carcinoma, psychosis; morphine,
myxedema; positive isoproteronal
pressure ventilation
Sym ptoma tolo g y
 Oliguria
 Edema (rare [water retention, water overload >
4 L - increase CVP, increase PWP – much of
 Weight gain is within cellular boundaries
 Anorexia
 Nausea and vomiting
 Muscle weakness, Muscle twitching, Lethargy,
Restlessness, Possible seizure, Confusion,
Pathophysiolo g y


Increase secretion of ADH in the

Blood stream

Increases the permeability to water in the

nephrons of kidneys

Water absorption/retention
Assessment / Diagnostics:

 Urine specific gravity > 1.030

 Dilutional of euvolemic hyponatremia (< 135

mEq/L): mild (< 135); moderate (< 130);
severe (< 125)
 Serum hypoosmolarity (< 280 mOsm/kg H2O)
 Normal renal function
 CT scan, MRI
 correction of underlying cause of SIADH (e.g.,
tumor surgery, radiation, chemotherapy)
 Drugs: – Cornivaptan (Vaprisol) is anti-ADH only
in IV form so cannot be used in outpatient setting
 Diuretics such as furosemide (Lasix)
 Ototoxication
 Demeclocycline – to block renal response to ADH
 not used during the acute phase overdose
 may cause diabetes insipidus
Nursing Diagnoses

• Excess Fluid Volume R/T ↑ ADH

• Risk for Injury R/T seizure
• Altered Urinary Elimination r/t excess
ADH level
• Knowledge Deficit: Disease process
r/t unfamiliarity of the illness
• 1. Need to maintain water restriction
at home to prevent water
• 2. Get daily weight. Call Dr. if ↑ in
weight is ≥ 1 kg/day.