Hyponatremia and SIADH: A Case Study for Nursing Consideration.

The leading cause of hyponatremia in patients with cancer is syndrome of inappropriate antidiuretic hormone secretion (SIADH); this oncologic emergency requires immediate intervention. Left untreated, it can result in increased mortality and morbidity. A sodium level less than 135 meq/L is an electrolyte irregularity and defined as hyponatremia. It is extremely critical that oncology nurses are knowledgeable and able to evaluate and determine when patients are in fluid and electrolyte crisis. Nurses should be aware of the specific cancers and treatments that put patients at risk for developing hyponatremia. This article presents a case study for nursing consideration.

Managing the patient with transsphenoidal pituitary tumor resection.

Patients who undergo transsphenoidal pituitary tumor resection require a multidisciplinary team approach, consisting of a neurosurgeon, an endocrinologist, and nurses. Successful transsphenoidal surgery needs expert nursing care for early identification and prompt treatment of pituitary dysfunction and neurosurgical complications. Pituitary dysfunction includes adrenal insufficiency, diabetes insipidus, syndrome of inappropriate antidiuretic hormone, and cerebral salt wasting syndrome. Neurosurgical complications may include visual disturbance, cerebrospinal fluid leak, subdural hematoma, and epistaxis.

Central neurogenic diabetes insipidus, syndrome of inappropriate secretion of antidiuretic hormone, and cerebral salt-wasting syndrome in traumatic brain injury.

Central neurogenic diabetes insipidus, syndrome of inappropriate secretion of antidiuretic hormone, and cerebral salt-wasting syndrome are secondary events that affect patients with traumatic brain injury. All 3 syndromes affect both sodium and water balance; however, they have differences in pathophysiology, diagnosis, and treatment. Differentiating between hypernatremia (central neurogenic diabetes insipidus) and the 2 hyponatremia syndromes (syndrome of inappropriate secretion of antidiuretic hormone, and cerebral salt-wasting syndrome) is critical for preventing worsening neurological outcomes in patients with head injuries.

Syndrome of inappropriate secretion of antidiuretic hormone in malignancy.

OBJECTIVES: To provide a review of pathophysiology, epidemiology, signs and symptoms, diagnosis, treatment, and nursing management of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in malignancy. DATA SOURCES: Research reports, review articles, and book chapters relevant to SIADH. CONCLUSIONS: The principle cause of hyponatremia in malignancy is SIADH. Early recognition and prompt treatment can prevent serious neurologic sequelae. Antineoplastic therapy and methods to correct hyponatremia constitute effective treatment strategies. IMPLICATIONS FOR NURSING PRACTICE: Nurses play a major role in nursing assessment, appropriate interventions and symptom control, and promoting resolution of problems and optimal quality of life in patients with malignancy complicated by SIADH.

Hematologic emergencies in the intensive care unit.

Hematologic emergencies in the oncology population may require an admission to the intensive care unit (ICU). Syndrome of inappropriate antidiuretic hormone, hypercalcemia, tumor lysis syndrome, and disseminated intravascular coagulation are diseases defined in this article. These are common conditions in oncology patients that are reduced or prevented with close monitoring and accurate assessments. The purpose of this article is to introduce intensive care nurses to these disease entities so they will have a better understanding of the care involved with an oncology patient in the ICU unit.

Síndrome de Bartter

En 1962 Bartter y colaboradores describieron un síndrome caracterizado por la presencia de hipokalemia, alcalosis, hiperreninemia e hiperaldosteronismo con tensión arterial normal, asociados a hipertrofia del aparato yuxtaglomerular. Investigaciones posteriores han podido concluir que esta condición es la expresion común de por lo menos tres bien definidos defectos funcionales del tubulo renal. Existen en la literatura informes de casos de esta entidad (1,2), pero por ser poco común, por lo inusual de la presentacion y por las dificultades diagnosticas a las que nos enfrentamos, informamos este caso.

Diabetes insipidus and syndrome of inappropriate secretion of antidiuretic hormone in children with midline suprasellar brain tumors.

Salt and water balance within the body is controlled by the hormonal influence of vasopressin. Vasopressin is produced in the hypothalamus, stored and released from the posterior lobe of the pituitary, and travels via the blood to the kidneys to regulate the amount and concentration of urine excreted. Oversecretion or undersecretion of vasopressin, eg, diabetes insipidus (DI) or syndrome of inappropriate secretion of antidiuretic hormone (SIADH) results in an imbalance of the salt-to-water ratio. In children this hormonal imbalance may occur secondary to a suprasellar brain tumor and/or the treatment of such. Approximately 50% to 75% of children with suprasellar tumors will develop permanent DI and the remainder will experience transient postoperative DI or SIADH. Pathophysiology of vasopressin's control on salt and water balance and its relationship to suprasellar brain tumors in children are presented. Nursing assessment and intervention parameters for management of DI and SIADH in children with brain tumors are also discussed.

Diabetes insipidus versus syndrome of inappropriate antidiuretic hormone.

Diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone (SIADH) are two endocrine disorders presenting a challenge to the critical care nurse. The challenge lies in the recognition and assessment of the effects on the patient's fluid balance and in the planning of interventions to prevent complications.

Syndrome of inappropriate antidiuretic hormone: assessment and nursing implications.

Syndrome of inappropriate antidiuretic hormone (SIADH) is a condition characterized by serum hypoosmolality and hyponatremia, resulting from the aberrant or sustained secretion of antidiuretic hormone (ADH). Its most frequent cause is malignancy, of which small cell or oat cell bronchogenic carcinoma is most common. Because it mimics the clinical manifestations of various disorders, SIADH often is difficult to diagnose. However, with early detection and prompt management, it can be reversed. The oncology nurse frequently is in a position to assist in the early recognition of this condition. The ability to maintain a high index of suspicion for patients at risk is critical to prompt recognition. Familiarity with the conditions that lead to this crisis and its early signs are essential to establishing a diagnosis and administering prompt treatment.

Fluid and electrolyte problems associated with diabetes insipidus and syndrome of inappropriate antidiuretic hormone.

This article has presented the complex system by which the hypothalamus regulates body fluid balance. In summary, ADH is synthesized and released via the hypothalamohypophyseal system. The supraoptic nucleus in the hypothalamus produces the ADH and the neurohypophysis stores and releases it. Osmoreceptors in the hypothalamus sense minute changes in the extracellular osmolality and stimulate or inhibit ADH synthesis and secretion. At the same time the thirst center of the hypothalamus is stimulated by the extracellular osmolality and brings conscious awareness of thirst into play. Once ADH is secreted, its target organ is the kidney, specifically the collecting ducts and distal tubules. Blood volume, blood pressure, emotional input, medications, and various pathologic conditions also affect ADH synthesis and secretion. As with any complex system there are numerous opportunities for a breakdown to occur. The most common types of pathologic conditions are the various forms of DI and SIADH. Both of these disorders have numerous causes, which must be identified prior to effective treatment. Serum and urine osmolality and sodium content are of use in diagnosing the disorders. Treatment is then geared toward correcting the underlying problem and controlling water balance, usually through pharmacologic agents. Nursing care includes meeting both the physical and psychologic needs of patients and educating them in the process of living with their transient or permanent condition.