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Syndrome of inappropriate Antidiuretic hormone - Coggle Diagram
Syndrome of inappropriate Antidiuretic hormone
Defination
It is the abnormal high production of Antidiuretic hormone
Aetiology
Malignancy (small cell carcinoma of the lungs, pancreatic cancer, thymus cancer, prostate Cancer or colorectal cancer).
Miscellaneous condition ( hypothyroidism, lung infection,chronic obstructive pulmonary diseases, HIV and adrenal insufficiency).
Central nervous system (head injury, stroke, brain tumours, encephalitis, meningitis and carebral atrophy.
Drug therapy ( carbamazepin, chlorpromide, oxytocin and thiazide diuretics
Nursing management
Intake and output, vital signs, heart sounds and lung sounds should be monitored.
Observe seizures, nausea and vomitting, muscle cramps and neurological distinction.
To treat serum sodium deficiency 800-1000 ml/day of fluid
Bed should be elevated to 10 degree, to prevent venous return to the heart and release of ADH.
Help the patient to change positions in order to maintain skin integrity and joint mobility.
Provide alarm and ambulation to protect injury.
To relieve discomfort of thirst from fluid restriction, oral care is important.
Treatment)
Hypertonic saline solution (3%-5%) must be slowly administered
Frusemide may be used prevent diuresis
For severe hyponatreamia , fluids must be stricted to 450 ml/day
Ice chips and sugarless chewing gums helps decrease thirst
Patient should take sodium and potassium supplement
Patient should be weighed to check for fluid or electrolyte imbalance.
Pathophysiology
Increased antidiuretic hormone
Which results to increased water reabsorption in renal tubules
Increased intravascular fluid volume
Dilutional hyponatraema and increased serum osmolality
Clinical manifestations
Reabsorption of water in the circulation
Extracellular fluid volume expands
Patient may present with thirst, dyspnoea on exertion and fatigue
Increasing permeability of renal and distal tubules
Diagnostic studies
Simultaneous measurements of urine and serum osmolality
Serum osmolality should less than urine osmolality which indicates the inappropriate exertion of concentrated urine in presence of urine dilute serum.
References
Brown D, Edwards H, Seaton L, Buckley T & Katherine A.K (2015).Lewis Medical-surgical Nursing: Nursing Management of endocrine problems, 4th edition, chapter 39, elsevier health sciences