Antidiuretic hormone inappropriate

Syndrome of inappropriate antidiuretic hormone is defined by water retention, dilutional hyponatraemia and decreased volume of highly concentrated urine. There are several causes which can result in SIADH, neoplasms ectopic secreting AVP, ectopic release of AVP by various diseases or drugs, exogenous administration of AVP, desmopressin, lysipressin or large doses of OT (iatrogenic SLADH). 

In addition, several other organs, like the heart, ovaty, amnion, chorion, decidua, testis, epididymis and prostate, have been reported to synthesize OT, suggesting a paracrine role for this hormone in these tissues. Ectopic AVP production by lung cancer cells or other neoplasms has been described in humans, leading to the syndrome of inappropriate antidiuretic hormone secretion. 

Satchell SC, Connaughton M Inappropriate antidiuretic hormone secretion and extreme rises in serum creatinine kinase following MDMA ingestion. Br J Hosp Med 51 495, 1994... 

Oxcarbazepine Hyponatremia (serum sodium concentrations less than 125 mEq/L) has been reported and occurs more frequently during the first 3 months of therapy serum sodium concentrations should be monitored in patients receiving drugs that lower serum sodium concentrations (e.g., diuretics or drugs that cause inappropriate antidiuretic hormone secretion) or in patients with symptoms of hyponatremia (e.g., confusion, headache, lethargy, and malaise). Hypersensitivity reactions have occurred in approximately 25-30% of patients with a history of carbamazepine hypersensitivity and requires immediate discontinuation. 

SIADH Syndrome of inappropriate antidiuretic hormone TID Three times daily (ter in die)... 

Paraneoplastic syndromes commonly associated with lung cancers include cachexia, hypercalcemia, syndrome of inappropriate antidiuretic hormone secretion, and Cushing s syndrome. 

Causes of nonosmotic release of arginine vasopressin, commonly known as antidiuretic hormone, include hypovolemia decreased effective circulating volume as seen in patients with congestive heart failure nephrosis cirrhosis and syndrome of inappropriate antidiuretic hormone (SIADH) release. 

FIGURE 78-1. Diagnostic algorithm for the evaluation of hyponatremia. (CHF, congestive heart failure EABV, effective arterial blood volume SIADH, syndrome of inappropriate antidiuretic hormone UNa, urine sodium concentration Uosm, urine osmolality.)... 

While the dose-limiting toxicity for vinblastine usually is leukopenia, that for vincristine is most commonly neurotoxicity (58). Prominent manifestations of neurotoxicity are loss of the Achilles tendon reflex, paresthesias, loss of muscle strength (e.g., in the foot and wrist), and ataxia. Constipation and abdominal pain may occur and are thought to result, at least in part, from actions on the autonomic nervous system. Leukopenia and stomatitis are possible effects of vincristine treatment, but they occur relatively infrequently. Alopecia occurs with vincristine at a frequency comparable to that observed with vinblastine, and vincristine also is a potent tissue irritant. Vincristine may produce a syndrome of inappropriate secretion of antidiuretic hormone, and some manifestations of neurotoxicity, such as seizures, have been considered to be due to electrolyte disturbances associated with the relative excess of the antidiuretic hormone (58). 

Because of sensory neuropathy, deep pain is often experienced by patients given vincristine. Through involvement of the glossopharyngeal nerve, throat pain may occur, as may deep pain of almost any other area of the body (31,32). Neuropathic changes are not always peripheral. Hallucinations and overall mental status changes, such as depression and/or psychosis, are also rarely reported (31,32). Another CNS effect is the syndrome of inappropriate antidiuretic hormone secretion, which is a well-characterized side effect of vincristine (31,32). 

Loss of blood glucose control When a patient stabilized on any diabetic regimen is exposed to stress such as fever, trauma, infection, or surgery, a loss of control may occur. At such times, it may be necessary to discontinue the drug and give insulin. Disulfiram-like syncframe. A sulfonylurea-induced facial flushing or breathlessness reaction may occur when some sulfonylureas are administered with alcohol. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) Water retention and dilutional hyponatremia have occurred after administration of sulfonylureas to type 2 diabetes patients, especially those with CHF or hepatic cirrhosis. 

Other-Fever, flushing hyperglycemia inappropriate antidiuretic hormone syndrome rash alopecia. Ethylenediamine in aminophylline can cause sensitivity reactions, including exfoliative dermatitis and urticaria. Cardiovascular Palpitations tachycardia extrasystoles hypotension circulatory failure life-threatening ventricular arrhythmias. 

SIADH syndrome of inappropriate antidiuretic hormone SL sublingual... 

Carbamazepine stimulates antidiuretic hormone activity and has been used for the treatment of neurohypophyseal diabetes insipidus. Carbamazepine induces microsomal enzymes and its metabolism is subject to auto-induction. Frequently occurring adverse effects are sedation, dry mouth, dizziness and gastrointestinal disturbances. Photosensitivity reactions, urticaria and Stevens-Johnson syndrome have been described. The elderly are more prone to mental confusion, cardiac abnormalities and problems due to inappropriate ADH secretion. 

Vincristine displays limited myelosuppression but its neurotoxicity is dose limiting. On the other hand the most important toxicity of vinblastine is myelosuppression while it lacks serious risks for neurotoxicity. The toxicity spectrum of vindesine and of vinorelbine is between these two extremes. The vinca alkaloids can cause inappropriate secretion of antidiuretic hormone. 

Nephrogenic diabetes insipidus is due to resistance to action of vasopressin, and therefore DDAVP is not indicated, but some benefit may be gained by using thiazide diuretics or chlorpropamide. The syndrome of inappropriate antidiuretic hormone (SIADH) can be treated by using the antibiotic derivative demeclocycline to induce a state of vasopressin resistance and partial nephrogenic diabetes insipidus. 

Inappropriate use of oxytocin can lead to uterine rupture, anaphylactoid and other allergic reactions, and possibly maternal death. Prolonged stimulation of uterine contractions can result in the following fetal adverse reactions persistent uteroplacental insufficiency, sinus bradycardia, premature ventricular contractions, other arrhythmias, and fetal death. Prolonged use of oxytocin can lead to water intoxication secondary to the antidiuretic hormone-like effects of oxytocin. Maternal and fetal cardiovascular parameters should be monitored during oxytocin administration. 

Bouman WP Pinner G, lohnson H. Incidence of selective serotonin reuptake inhibitor (SSRI) induced hyponatraemia due to the syndrome of inappropriate antidiuretic hormone (SIADH) secretion in the elderly. Int 1 Geriatr Psychiatry 1998,13 12-15. 

Abbreviations CNS, central nervous system COX, cyclooxygenase Gl, gastrointestinal NSAlDs, nonsteroidal anti-inflammatory drugs SIADH, syndrome of inappropriate antidiuretic hormone secretion. From Pick DM, Cooper IW, Wade WE, et al Updating the Beers criteria for potentially inappropriate medication use in older adults Results of a U.S. consensus panel of experts. Arch Intern Med 2003 163 2716. 

Liu, B.A., Mittmann, N., Knowles, S.R., and Shear, N.H. (1996) Hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone associated with the use of selective serotonin reuptake inhibitors a review of spontaneous reports. CMAJ 155 519-527. 

BUN, blood urea nitrogen CBC, complete blood cell count CBZ, carbamazepine DVP, divalproex sodium EKG, electrocardiogram SIADH, syndrome of inappropriate secretion of antidiuretic hormone TSH, thyroid-stimulating hormone. 

Case reports have indicated an association between SSRIs and the syndrome of inappropriate secretion of antidiuretic hormone. Symptoms include lethargy, headache, hyponatremia, increased urinary sodium excretion, and hyperosmotic urine. Acute treatment of this syndrome should consist of discontinuation of the drug as well as restriction of fluid intake. Patients experiencing severe confusion, convulsions, or coma should receive intravenous sodium chloride. Elderly persons may he at a higher risk for developing this syndrome. 

Note. SIADH=syndrome of inappropriate secretion of antidiuretic hormone CBC=complete blood count TSH=thyroid-stimulating hormone ECG=electrocardiogram AST=aspartate aminotransaminase ALT=alanine aminolransaminase. 

The syndrome of inappropriate antidiuretic hormone secretion, with resultant hyponatremia, may be induced by carbamazepine treatment. Alcoholic patients may be at greater risk for hyponatremia. 

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