Syndrome of inappropriate antidiuretic hormone secretion - Revision history

JessicaLeungMD: Intraoperative management

2025-06-29T17:48:06Z

Intraoperative management

← Older revision		Revision as of 10:48, 29 June 2025
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	===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->===		===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->===

			* Serial ABG to monitor serum sodium
			** concern for ''overly rapid correction'' - potentially leading to OSD or CPM.
			*** Maintain sodium correction to 0.5mmol/L/hr with goal of 4-8mmol/L in ''24 hours''<ref>{{Cite web\|title=The Resuscitationist’s Approach to Severe Hyponatremia\|url=https://www.acep.org/criticalcare/newsroom/newsroom-articles/september2022/the-resuscitationists-approach-to-severe-hyponatremia\|access-date=2025-06-29\|website=www.acep.org\|language=en}}</ref>
			***
			* Avoid hypotonic fluids
			** half normal saline
			** dextrose in water
			** LR - can consider but requires very close monitoring of sodium levels
			* Preferred fluids
			** Hypertonic saline

	===Postoperative management<!-- Describe how this comorbidity may influence postoperative management. -->===		===Postoperative management<!-- Describe how this comorbidity may influence postoperative management. -->===
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	** Encephalitis		** Encephalitis
	** Brain trauma		** Brain trauma
	**		**Hypopituitarism
			**Stroke
			*Guillain-Barre
			*Heart Failure
			*Lung Pathology
			**Pneumonia
			*Medications
			**SSRIs
			**Anti-neoplastic drugs
			**Anti-psychotics
			*Acute stressors
			**pain
			**Nausea
			*Hypothoridism
			*HIV infection

	==Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. -->==		==Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. -->==
	[[File:Siadh vs di vs cerebral salt wasting.png\|thumb]]		[[File:Siadh vs di vs cerebral salt wasting.png\|thumb]]Symptoms

			* Cerebral
			** Altered mental status
			** Seizures
			** Loss of balance/coordination
			** Coma
			* GI
			** Nausea
			** Emesis
			* Musculoskeletal
			** Muscle cramps
			** Muscle weakness

	==Diagnosis==		==Diagnosis==

			* Hyponatremia (serum) x< 135 mEq/L
			* High urine osmolality: 100+ mOsm/kg
			* High Urine sodium levels 40+ mEq/L
			* Euvolemic or fluid overload state

	==Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. -->==		==Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. -->==

	~~===Medication<!~~-- ~~Describe medications used~~ to ~~manage this comorbidity. -->===~~		* Overall treatment is to remove excess water from the body
			* Diuretics
			* H20 restriction
			* Demeclocycline (off-label)
			** a tetracycline antibiotic that is used off-label to treat SIADH by decreasing renal response to ADH
			* Treat inciting etiology

	==~~=Surgery~~<!-- Describe ~~surgical procedures used to treat~~ this comorbidity. -->===		==Epidemiology<!-- Describe the epidemiology of this comorbidity -->==
			Risk factors for SIADH

	~~===Prognosis<!-- Describe the prognosis of this comorbidity -->===~~		* Increasing age
			* Hospitalization
	~~==Epidemiology<!-- Describe the epidemiology of this comorbidity -->==~~		* Lung cancer
			* Cerebral pathology/manipulation

	==References==		==References==
	<ref>{{Cite journal\|last=Leung\|first=Alexander A.\|last2=McAlister\|first2=Finlay A.\|last3=Rogers\|first3=Selwyn O., Jr\|last4=Pazo\|first4=Valeria\|last5=Wright\|first5=Adam\|last6=Bates\|first6=David W.\|date=2012-10-22\|title=Preoperative Hyponatremia and Perioperative Complications\|url=https://doi.org/10.1001/archinternmed.2012.3992\|journal=Archives of Internal Medicine\|volume=172\|issue=19\|pages=1474–1481\|doi=10.1001/archinternmed.2012.3992\|issn=0003-9926}}</ref>		<ref>{{Cite journal\|last=Leung\|first=Alexander A.\|last2=McAlister\|first2=Finlay A.\|last3=Rogers\|first3=Selwyn O., Jr\|last4=Pazo\|first4=Valeria\|last5=Wright\|first5=Adam\|last6=Bates\|first6=David W.\|date=2012-10-22\|title=Preoperative Hyponatremia and Perioperative Complications\|url=https://doi.org/10.1001/archinternmed.2012.3992\|journal=Archives of Internal Medicine\|volume=172\|issue=19\|pages=1474–1481\|doi=10.1001/archinternmed.2012.3992\|issn=0003-9926}}</ref>
	[[Category:Comorbidities]]		[[Category:Comorbidities]]

JessicaLeungMD: Started SIADH page, filled out pathophysiology, made chart for differential diagnosis and treatment

2025-06-29T17:24:57Z

Started SIADH page, filled out pathophysiology, made chart for differential diagnosis and treatment

← Older revision		Revision as of 10:24, 29 June 2025
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	}}		}}

	~~Provide~~ a ~~brief summary~~ of ~~this comorbidity here~~.		Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition in which ''excess'' anti-diuretic hormone (ADH) - also known as vasopressin - is produced. Downstream effects include 1. retention of excess water which can lead to cerebral edema/seizures/coma/death, 2. hyponatremia which can lead to arrhythmias and - if sodium corrected is attempted - potentially iatrogenic Osmotic demyelination syndrome (OSD)/Central pontine myelinolysis (CPM).

	== Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> ==		==Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. -->==

	=== Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --> ===		===Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. -->===

	~~=== Intraoperative management~~<~~!-- Describe how this comorbidity may influence intraoperative management~~. ~~--> ===~~		* Evaluate overall sodium trend
			** Most anesthesiologists would consider delaying case if sodium x<130
			** Ideally sodium should be corrected to normal limits or at least ''stabilized or trending towards correction'' prior to surgery
			*** Uncorrected sodium levels merits discussion with internal medicine and surgery.

	=== ~~Postoperative~~ management<!-- Describe how this comorbidity may influence ~~postoperative~~ management. --> ===		===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->===

	== ~~Related surgical procedures~~<!-- ~~List and briefly describe any procedures which may be performed specifically to treat~~ this comorbidity ~~or its sequelae. If none, this section~~ may ~~be removed~~. --> ==		===Postoperative management<!-- Describe how this comorbidity may influence postoperative management. -->===

	== ~~Pathophysiology~~<!-- ~~Describe the pathophysiology of~~ this comorbidity. ~~Add subsections as needed~~. --> ==		==Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. -->==

	== ~~Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. -->~~ ==		==Pathophysiology==
			General Mechanism of Action of ADH

	~~== Diagnosis<!~~-~~- Describe how this comorbidity is diagnosed~~. ~~--> ==~~		* ADH is a hormone produced by the hypothalamus, then stored and released via the posterior pituitary gland
			* ADH is responsible for mechanisms pertaining to water retention via upregulation of aquaporin channels in renal nephrons to increase water re-absorption. ADH's main effect leads to increased fluid volume while decreasing serum sodium concentration and decreasing urinary output volume.

	~~== Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. --> ==~~		Consequences

	~~=== Medication<!-- Describe medications used to manage this comorbidity. --> ===~~		Causes

	~~===~~ Surgery<!-~~- Describe surgical procedures used to treat this comorbidity. --> ===~~		* Cancer
			** Brain tumors
			** Small Cell Lung Cancer
			** Lymphoma
			* Central Nervous System
			** Brain Surgery - especially pituitary gland surgery
			** Brain tumors
			** Meningitis
			** Encephalitis
			** Brain trauma
			**

	==~~= Prognosis~~<!-- Describe the ~~prognosis~~ of this comorbidity --> ===		==Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. -->==
			[[File:Siadh vs di vs cerebral salt wasting.png\|thumb]]

	== ~~Epidemiology<!-- Describe the epidemiology of this comorbidity -->~~ ==		==Diagnosis==

	== ~~References~~ ==		==Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. -->==

			===Medication<!-- Describe medications used to manage this comorbidity. -->===

			===Surgery<!-- Describe surgical procedures used to treat this comorbidity. -->===

			===Prognosis<!-- Describe the prognosis of this comorbidity -->===

			==Epidemiology<!-- Describe the epidemiology of this comorbidity -->==

			==References==
			<ref>{{Cite journal\|last=Leung\|first=Alexander A.\|last2=McAlister\|first2=Finlay A.\|last3=Rogers\|first3=Selwyn O., Jr\|last4=Pazo\|first4=Valeria\|last5=Wright\|first5=Adam\|last6=Bates\|first6=David W.\|date=2012-10-22\|title=Preoperative Hyponatremia and Perioperative Complications\|url=https://doi.org/10.1001/archinternmed.2012.3992\|journal=Archives of Internal Medicine\|volume=172\|issue=19\|pages=1474–1481\|doi=10.1001/archinternmed.2012.3992\|issn=0003-9926}}</ref>
	[[Category:Comorbidities]]		[[Category:Comorbidities]]

Oliviamsutton: Created page with "{{Infobox comorbidity | other_names = | anesthetic_relevance = | specialty = | signs_symptoms = | diagnosis = | treatment = | image = | caption = }} Provide a brief s..."

2022-01-24T20:04:20Z

Created page with "{{Infobox comorbidity | other_names = | anesthetic_relevance = | specialty = | signs_symptoms = | diagnosis = | treatment = | image = | caption = }} Provide a brief s..."

New page

{{Infobox comorbidity
| other_names =
| anesthetic_relevance =
| specialty =
| signs_symptoms =
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Provide a brief summary of this comorbidity here.

== Anesthetic implications ==

=== Preoperative optimization ===

=== Intraoperative management ===

=== Postoperative management ===

== Related surgical procedures ==

== Pathophysiology ==

== Signs and symptoms ==

== Diagnosis ==

== Treatment ==

=== Medication ===

=== Surgery ===

=== Prognosis ===

== Epidemiology ==

== References ==

[[Category:Comorbidities]]