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Evaluation and Investigation of Pituitary Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Hyponatraemia has numerous causes and SIADH is an important one. SIADH is a diagnosis of exclusion. SIADH can be confirmed with paired urine and serum sodium osmolalities. Hyponatraemia demonstrated by reduced serum osmolality and associated with inappropriately high urinary sodium and osmolality confirms the diagnosis.
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Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Hyponatraemia is common, and is often found as an incidental finding in patients presenting to hospital for other reasons. Symptoms of hyponatraemia will depend on how quickly the level has fallen and how low it is, varying from nausea, malaise and headache to confusion, seizures and coma. There are many causes of hyponatraemia, and the first step to identifying the underlying cause is to work out the patient’s volume status, i.e. are they hypovolaemic, euvolaemic or hypervolaemic? Hypervolaemic causes tend to be due to nephrotic syndrome or failure of the heart, liver or kidneys. In patients found to be hypovolaemic, urinary sodium should be measured and will give an indication as to whether the sodium is being lost renally (urinary Na > 20) or extra-renally (urinary Na < 20). Renal losses include Addison’s disease, diuretics and the diuretic phase of renal failure. Extra-renal losses include diarrhoea, vomiting, bums and fistulae. In euvolaemic patients, urine osmolality should be requested. If this is low, i.e. < 500mmol/kg, this may be due to hypothyroidism or water excess, e.g. psychogenic polydipsia. If the urine osmolality is high (> 500mmol/kg), the likely diagnosis is SIADH. The causes of SIADH are vast, and management often requires treatment of the underlying cause, strict fluid restriction and, occasionally, demeclocycline.
EMI – investigations in psychiatry
Published in Bhaskar Punukollu, Michael Phelan, Anish Unadkat, MRCPsych Part 1 In a Box, 2019
Bhaskar Punukollu, Michael Phelan, Anish Unadkat
3. D, H: Syndrome of Inappropriate Secretion of ADH (SIADH). SIADH may be caused by: oat cell carcinoma of the lung; COAD; pancreatic cancer; Hodgkin’s disease; CNS disorders – cerebral abscess, meningitis, encephalitis; myxoedema; certain drugs – antidepressants, neuroleptics, carbamazepine, diuretics, oral hypoglycaemic agents. Investigations reveal: low serum Na; elevated urine Na; low serum osmolality; high urine osmolality (highly concentrated urine).
A rare report of obstructive nephropathy induced hyponatremia
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Sherif Elkattawy, Tanya Shankar, Islam Younes, Ramez Alyacoub, Hardik Fichadiya, Aravinda Reddy
In elderly patients, hyponatremia is multifactorial. It can be due to age-related loss of nephrons and decrease in GFR, decrease in total body water, diminished thirst mechanism or ‘tea and toast’ diet. These factors cause increased passive reabsorption of water in the distal tubule and thereby impair urinary diluting capacity [7,8]. Medications such as diuretics or antidepressants precipitating SIADH can also play a major role [10]. The diagnostic criteria for SiADH includes clinical euvolemia, serum sodium <135 mEq/L, urine osmolarity >100 mOsmol/kg, serum osmolarity <275 mOsmol/kg, urine sodium >40 mmol/L, and absence of other causes of hyponatremia, e.g., adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, and drugs that impair kidney water excretion [11].
Fatal serotonin syndrome: a systematic review of 56 cases in the literature
Published in Clinical Toxicology, 2021
Sanjay Prakash, Chaturbhuj Rathore, Kaushik Rana, Anurag Prakash
About 50% (n = 28) patients developed some form of cardiac complications and it was the most common reason for the fatality (Table 3). Cardiopulmonary arrest was the most common complication (20%) in this observation. The other cardiac complications were different forms of arrhythmia (18%), left ventricular dysfunction/heart failure (5%), and circulatory collapse (4%). Disseminated intravascular coagulation (DIC), multi-organ failure (MOF), and acute renal failure (ARF) were noted with equal frequency (16% each). Rhabdomyolysis was reported in 13% of cases. The respiratory complications include pulmonary edema (7%), acute respiratory distress syndrome (ARDS) (4%), and pulmonary embolism (4%). Trismus led to difficult intubations and to immediate death in three patients [10, 11, 13]. Other rare complications included hypertensive crisis, cerebral hemorrhage, cerebral infarct, cerebral edema, syndrome of inappropriate antidiuretic hormone secretion (SIADH), and limb ischemia (one patient each).
The many manifestations of a single disease: neuroborreliosis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Sajida Zulfiqar, Anum Qureshi, Ranadheer Dande, Chahat Puri, Kia Persaud, Shankar Awasthi
There have been a few case reports of SIADH associated with neuroborreliosis. SIADH has multiple etiologies including malignancy (most common), medication-induced, non-malignant pulmonary disease and less commonly, infection of the central nervous system [9]. There is thought to be an elevation of interleukin-6 (inflammatory cytokine) in CSF of patients with LNB [10] inducing the release of antidiuretic hormone (ADH). Our patient had lymphocytic pleocytosis and elevated CSF proteins in the setting of positive Lyme serology, pointing towards neuroborreliosis as the driving force behind SIADH. Although she was treated with fluid restriction, treatment for neuroborreliosis was also started which seemed to help with resolution of hyponatremia. Some case reports have reported an association between LNB and SIADH [7]. As a well-known fact, the treatment of SIADH is to identify and treat the underlying cause. Although our patient did not present with signs of meningeal irritation, her CSF analysis was consistent with aseptic meningitis suggesting inflammation and, therefore, release of ADH causing SIADH. Therefore, Lyme disease should be suspected in patients who are from Lyme endemic areas and present with ileus and SIADH with or without cranial nerve palsy. A careful history and examination can clue clinicians into the diagnosis and appropriate treatment.