Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

In this video we're walking through the pathophysiology and signs and symptoms of syndrome of inappropriate antidiuretic hormone, also known as SIADH. You won't need to memorize a list of symptoms for your nursing school exam, but you'll actually understand the critical thinking behind it.

SIADH Pathophysiology

SIADH is focused on a hormone called ADH, anti diuretic hormone, which is released from the posterior pituitary gland. In SIADH, there is too much ADH being released. This can be caused by things like nervous system disorders or tumors. 

1. ADH is released from the posterior pituitary gland, regardless of fluid volume
2. ADH travels down to the kidneys
3. The kidneys respond to the ADH and hold onto more water, rather than sending it out into the urine
4. Fluid volume in the body goes up because of all the extra water the kidneys are holding onto
5. Sodium level in the body will decrease because the sodium is being DILUTED by all of that extra water
                                                                                         
During SIADH, the sodium level in the body will be LOW, NOT because there is less sodium, but because there is just more water diluting the sodium out. 

SIADH Signs and symptoms

Water retention: ADH tells the kidneys to hold on to water, instead of sending it out into the urine, and too much ADH is being released. Those two things lead to an increase fluid volume and a diluted lower sodium level. Weight gain will happen, simply because there is more water in the body.

Increased blood pressure: This increase in body water can also lead to higher blood pressure.

Increased heart rate: The patient may have an increased heart rate and a bounding pulse because there is more fluid inside the blood vessels.

Decreased urine output: The kidneys are holding onto more water, and the urine that is made is very concentrated.

GI disturbances: Nausea, vomiting, and a loss of appetite, can happen because the sodium is being diluted. Sodium plays an important role in muscle contraction within the GI tract, so without it, GI muscles can't do their job as effectively. 

Diminished deep tendon reflexes: Sodium plays such a key role in muscle contraction. Without it, the muscles can't contract. 

Mental status changes: Without enough sodium in the blood, the patient may have some mental status changes, like headaches, lethargy, confusion, seizures and even coma. The shifts in fluid also can cause these neurological changes to happen, because it actually can shift into the cerebrospinal fluid and cause brain swelling. These changes in neurological function is also what causes the body temperature to change. The central nervous system needs sodium and proper fluid balance to function optimally. 


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TIMESTAMPS:
0:00 Intro
1:00 Definition
2:18 Normal Function of ADH
2:51 During SIADH
5:12 Signs and Symptoms


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