Etiology
Neuropschiatric Disease
- Acute Intermittent Porphyria (see Acute Intermittent Porphyria, [[Acute Intermittent Porphyria]])
- Acute Psychosis (see Psychosis, [[Psychosis]])
- Anoxic/Hypoxic/Ischemic Encephalopathy (see Anoxic Encephalopathy, [[Anoxic Encephalopathy]])
- Brain Abscess (see Brain Abscess, [[Brain Abscess]])
- Cavernous Sinus Thrombosis (see Cerebral Venous Thrombosis, [[Cerebral Venous Thrombosis]])
- Cerebellar/Cerebral Atrophy
- Delirium Tremens/Ethanol Withdrawal (see Ethanol, [[Ethanol]])
- Epilepsy (see Seizures, [[Seizures]])
- Guillain-Barre Syndrome (see Guillain-Barre Syndrome, [[Guillain-Barre Syndrome]])
- Encephalitis (see Encephalitis, [[Encephalitis]])
- Head Trauma (see Head Trauma, [[Head Trauma]])
- Hydrocephalus (see Hydrocephalus, [[Hydrocephalus]])
- Intracerebral Hemorrhage (see Intracerebral Hemorrhage, [[Intracerebral Hemorrhage]])
- Ischemic Cerebrovascular Accident (CVA) (see Ischemic Cerebrovascular Accident, [[Ischemic Cerebrovascular Accident]])
- Lupus Cerebritis (see Systemic Lupus Erythematosus, [[Systemic Lupus Erythematosus]])
- Meningitis (see Meningitis, [[Meningitis]])
- Midfacial Hypoplasia
- Multiple Sclerosis (see Multiple Sclerosis, [[Multiple Sclerosis]])
- Perinatal Hypoxia
- Rocky Mountain Spotted Fever (see Rocky Mountain Spotted Fever, [[Rocky Mountain Spotted Fever]])
- Schizophrenia (see Schizophrenia, [[Schizophrenia]])
- Shy-Drager Syndrome (see Shy-Drager Syndrome, [[Shy-Drager Syndrome]])
- Subarachnoid Hemorrhage (SAH) (see Subarachnoid Hemorrhage, [[Subarachnoid Hemorrhage]])
- Subdural Hematoma (see Subdural Hematoma, [[Subdural Hematoma]])
- Varicella-Zoster Virus (VZV) Infection of Chest Wall (see Varicella-Zoster Virus, [[Varicella-Zoster Virus]])
- Ventriculoatrial Shunt Obstruction
- Wernicke Encephalopathy (see Thiamine, [[Thiamine]])
Gastrointestinal Disease
- Acute Intermittent Porphyria (see Acute Intermittent Porphyria, [[Acute Intermittent Porphyria]])
- Nausea (see Nausea and Vomiting, [[Nausea and Vomiting]]): stimulation of vasopressin secretion
Neoplastic Disease
- Adrenocortical Carcinoma
- Brain Tumor
- Carcinoid Tumor
- Bronchial Carcinoid (see Bronchial Carcinoid, [[Bronchial Carcinoid]])
- Cervical Cancer (see Cervical Cancer, [[Cervical Cancer]])
- Colorectal Cancer (see Colorectal Cancer, [[Colorectal Cancer]])
- Duodenal Carcinoma
- Ewing Sarcoma
- Leukemia
- Lung Cancer (see Lung Cancer, [[Lung Cancer]])
- Small Cell Lung Cancer (see Lung Cancer, [[Lung Cancer]])
- Lymphoma (see Lymphoma, [[Lymphoma]])
- Mesothelioma (see Mesothelioma, [[Mesothelioma]])
- Nasopharyngeal Carcinoma (see Nasopharyngeal Carcinoma, [[Nasopharyngeal Carcinoma]])
- Neuroblastoma: olfactory
- Ovarian Cancer (see Ovarian Cancer, [[Ovarian Cancer]])
- Pancreatic Cancer (see Pancreatic Cancer, [[Pancreatic Cancer]])
- Prostate Cancer (see Prostate Cancer, [[Prostate Cancer]])
- Thymoma (see Thymoma, [[Thymoma]])
- Urothelial Cell Carcinoma (see Urothelial Cell Carcinoma, [[Urothelial Cell Carcinoma]])
- Bladder Cancer (see Bladder Cancer, [[Bladder Cancer]])
- Ureteral Cancer (see Ureteral Cancer, [[Ureteral Cancer]])
Pulmonary Disease
- Acute Bronchitis (see Acute Bronchitis, [[Acute Bronchitis]])
- Acute Respiratory Failure/Mechanical Ventilation (see Respiratory Failure, [[Respiratory Failure]])
- Aspergillosis (see Aspergillus, [[Aspergillus]]): cavitary
- Asthma (see Asthma, [[Asthma]])
- Atelectasis (see Atelectasis, [[Atelectasis]])
- Bronchiolitis (see Bronchiolitis, [[Bronchiolitis]])
- Chronic Obstructive Pulmonary Disease (COPD) (see Chronic Obstructive Pulmonary Disease, [[Chronic Obstructive Pulmonary Disease]])
- Cystic Fibrosis (CF) (see Cystic Fibrosis, [[Cystic Fibrosis]])
- Empyema (see Pleural Effusion-Parapneumonic, [[Pleural Effusion-Parapneumonic]])
- Lung Abscess (see Lung Abscess, [[Lung Abscess]])
- Pneumonia (see Pneumonia, [[Pneumonia]])
- Pneumothorax (see Pneumothorax, [[Pneumothorax]])
- Pulmonary Fibrosis
- Idiopathic Pulmonary Fibrosis (IPF) (see Idiopathic Pulmonary Fibrosis, [[Idiopathic Pulmonary Fibrosis]])
- Sarcoidosis (see Sarcoidosis, [[Sarcoidosis]])
- Tuberculosis (see Tuberculosis, [[Tuberculosis]])
Drugs
Stimulation of Vasopressin Release
- Acetylcholine
- Amitriptyline
- Barbiturates (see Barbiturates, [[Barbiturates]])
- Bromocriptine
- Carbachol
- Carbamazepine (Tegretol) (see Carbamazepine, [[Carbamazepine]])
- Chlorpropamide (see Chlorpropamide, [[Chlorpropamide]])
- Clofibrate (Atromid-S) (see Clofibrate, [[Clofibrate]])
- Cyclophosphamide (Cytoxan) (see Cyclophosphamide, [[Cyclophosphamide]])
- Cyclopropane
- Desipramine
- Halothane
- Haloperidol (Haldol) (see Haloperidol, [[Haloperidol]])
- Histamine
- Ifosfamide (see Ifosfamide, [[Ifosfamide]])
- Isoproterenol (Isuprel) (see Isoproterenol, [[Isoproterenol]])
- Lorcainide
- Morphine (see Morphine, [[Morphine]])
- Nicotine (see Nicotine, [[Nicotine]])
- Nitrous Oxide (see Nitrous Oxide, [[Nitrous Oxide]])
- Oxcarbazepine
- Thioridazine
- Thiopental
- Tranylcypromine
- Vidarabine (see Vidarabine, [[Vidarabine]])
- Vinblastine (see Vinblastine, [[Vinblastine]])
- Vincristine (see Vincristine, [[Vincristine]])
Potentiation of Peripheral Activity of Vasopressin
- Clofibrate (Atromid-S) (see Clofibrate, [[Clofibrate]])
- Griseofulvin (see Griseofulvin, [[Griseofulvin]])
- Hypoglycemic Agents
- Metformin (see Metformin, [[Metformin]])
- Phenformin (see Phenformin, [[Phenformin]])
- Tolbutamide (see Tolbutamide, [[Tolbutamide]])
- Non-Steroidal Anti-Inflammatory Drugs (NSAID) (see Non-Steroidal Anti-Inflammatory Drug, [[Non-Steroidal Anti-Inflammatory Drug]]): inhibit renal PGE2 synthesis
- Oxytocin (see Oxytocin, [[Oxytocin]]): at high doses
- Theophylline (see Theophylline, [[Theophylline]])
- Triiodothyronine
- Vasopressin Analogs
- Vasopressin (see Vasopressin, [[Vasopressin]])
- Desmopressin (DDAVP) (see Desmopressin, [[Desmopressin]])
Unknown Mechanism
- Cisplatin (see Cisplatin, [[Cisplatin]])
- Melphalan (see Melphalan, [[Melphalan]])
- Methotrexate (see Methotrexate, [[Methotrexate]])
- Imatinib (Gleevec) (see Imatinib, [[Imatinib]])
- Ciprofloxacin (Cipro) (see Ciprofloxacin, [[Ciprofloxacin]])
- Clomipramine (see Clomipramine, [[Clomipramine]])
- Ecstasy (see Ecstasy, [[Ecstasy]])
- Phenoxybenzamine (see Phenoxybenzamine, [[Phenoxybenzamine]])
- Selective Serotonin Reuptake Inhibitors (SSRI) (see Selective Serotonin Reuptake Inhibitors, [[Selective Serotonin Reuptake Inhibitors]])
- Citalopram (Celexa) (see Citalopram, [[Citalopram]])
- Escitalopram (Lexapro) (see Escitalopram, [[Escitalopram]])
- Fluoxetine (Prozac) (see Fluoxetine, [[Fluoxetine]])
- Paroxetine (Paxil) (see Paroxetine, [[Paroxetine]])
- Sertraline (Zoloft) (see Sertraline, [[Sertraline]])
- Thiothixene
- Valproic Acid (see Valproic Acid, [[Valproic Acid]])
Other
- Exercise-Induced Hyponatremia
- Giant Cell Arteritis (see Temporal Arteritis, [[Temporal Arteritis]])
- Human Immunodeficiency Virus (HIV) (see Human Immunodeficiency Virus, [[Human Immunodeficiency Virus]]): Hyponatremia has been reported in as many as 40% of adult patients with HIV infection. Patients with acquired immunodeficiency syndrome (AIDS) can have many potential causes for increased ADH secretion, including volume depletion and infection of the lungs and the CNS.[5] Although one third of the hyponatremic patients with AIDS are clinically hypovolemic, the remaining hyponatremic patients fulfill most of the criteria for SIADH.
- Idiopathic SIADH
Diagnosis
-
In the absence of a single laboratory test to confirm the diagnosis, SIADH is best defined by the classic Bartter-Schwartz criteria, which can be summarized as follows[1] :
Hyponatremia with corresponding hypo-osmolality
Continued renal excretion of sodium
Urine less than maximally dilute
Absence of clinical evidence of volume depletion
Absence of other causes of hyponatremia
Correction of hyponatremia by fluid restriction -
The following laboratory tests may be helpful in the diagnosis of SIADH:
Serum sodium, potassium, chloride, and bicarbonate
Plasma osmolality
Serum creatinine
Blood urea nitrogen
Blood glucose
Urine osmolality
Serum uric acid
Serum cortisol
Thyroid-stimulating hormone
The patient’s volume should be assessed clinically to help rule out the presence of hypovolemia. -
Imaging studies that may be considered include the following:
- Chest radiography (for detection of an underlying pulmonary cause of SIADH)
- Computed tomography or magnetic resonance imaging of the head (for detection of cerebral edema occurring as a complication of SIADH, for identification of a CNS disorder responsible for SIADH, or for helping to rule out other potential causes of a change in neurologic status)
Clinical
- Hyponatremia (see Hyponatremia, [[Hyponatremia]])
Treatment
General Treatment
- Oral Fluid Restriction
Drug Therapy
- Conivaptan (Vaprisol) (see Conivaptan, [[Conivaptan]])
- Tolvaptan (Samsca) (see Tolvaptan, [[Tolvaptan]])
References
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