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Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Nonpharmacologic Interventions
Inappropriate Ant-tie-die-rocket with Harmonica and Nun-with-pills
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) occurs when antidiuretic hormone (ADH) which normally regulates the retention of water by the kidneys is secreted in inappropriately increased amounts. Treatment of SIADH is aimed at correcting dilutional hyponatremia, closely monitoring for electrolyte and weight changes, as well as administering medications to decrease fluid retention. This card will cover the nonpharmacologic interventions of monitoring of serum and urine osmolality, recording I&Os with daily weights, restriction of fluid intake, monitoring of cardiovascular and neurological status, as well as initiating seizure precautions.
5 KEY FACTS
Ensuring that serum osmolality increases and urine osmolality decreases allows the provider to confirm that the patient is losing serum volume into the urine.
Daily weights are the staple for monitoring fluid level in any patient. Carefully monitoring intake and output in these patients is also advised to prevent fluid overload.
There are not many instances where we restrict fluid intake in patients. SIADH patients are placed on a fluid restriction of 1L/day to promote an increase of serum osmolality. Severe cases may be restricted to 500mL/day.
Excess fluid volume in these patients causes shifts of electrolytes, especially sodium. Careful monitoring of these patient’s CNS function and cardiac status is imperative as these may deteriorate quickly.
Patients with dilutional hyponatremia are at an increased risk for seizures and should be placed on seizure precautions to ensure safety as low sodium levels often precipitate seizures.
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Is a condition that results from failure in the negative feedback mechanism that regulates inhibition and secretion of ADH. It produces excess ADH, resulting hypothermia and hypoosmolality of serum. The kidneys respond by reabsorbing water in the tubules and excreting sodium; thus the patient becomes severely water intoxicated. SIADH is most commonly caused by ectopic production of ADH by malignant tumors. It can be result of
CNS disorders, such as Guillain-Barre syndrome, meningitis, brain tumors, and head trauma. Pulmonary-related conditions, such as pneumonia, and positive pressure ventilation can cause SIADH. Pharmacologic agents such as general anesthetics, thiazine diuretics, oral hypoglycemics, chemotherapeutic agents, and analgesics are also associated with SIADH release. Excess fluid volume related to excessive amount of antidiuretic hormone secretion.
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Muscoloskeletal
Acute Care Patient ManagementNursing
Diagnosis:
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Outcome Criteria- Intake approximates output
- Serum potassium 3.5 to 5 mEq/L
- Serum sodium 135 to 145 mEq/L
- Serum chloride 95 to 105 mEq/L
- Serum osmolality 275 to 295 mOsm/kg
- Urine specific gravity 1.003 to 1.035
- CVP 2 to 6 mm Hg
- Monitor pulmonary artery pressures and central venous pressure hourly (if available) or more frequently to evaluate the patient’s response to treatment. Both parameters reflect the capacity of the vascular system to accept volume and can be used to monitor fluid volume status.
- Monitor hourly intake and output, and determine fluid balance every 8 hours. Compare serial weights and note rapid (0.5-1 kg/day) changes in weight, suggesting fluid imbalance.
- Continuously monitor ECG for dysrhythmias resulting from electrolyte imbalance.
- Obtain VS every hour or more frequently until the patient’s condition is stable.
- Evaluate hydration status every 4 hours. Note skin turgor on inner thigh or forehead, condition or buccal membranes, development of edema or crackles, and complaints of thirst.
- Assess for pressure ulcer development secondary to edematous state.
- Review serum sodium and potassium, serum osmolality, urine specific gravity, and urine osmolality to evaluate the patient’s response to therapy.
- Restrict fluid as ordered, generally <500 mL/day in severe cases and 800 to 1000 mL/day in moderate cases.
- Administer potassium supplements as ordered, assess renal function and ensure adequate urine output before administering potassium.
- As adjuncts to water restriction, demeclocycline may be ordered to inhibit the renal response to ADH in patients with lung malignancies.
- Avoid hypotonic enemas to treat constipation because water intoxication can be potentiated.
- Institute pressure ulcer prevention strategies.