Inappropriate Hyponatremia Essay

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EUVOLEMIC HYPONATREMIA: MECHANISM SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION [5,13] SIADH is the most common cause of hyponatremia [13]. It is caused by inappropriate vasopressin secretion either from the pituitary or from the ectopic source independent of the circulatory volume status and serum osmolality resulting in hyponatremia. Also there occurs inappropriate diuresis due to the action of vasopressin in the collecting tubules and its action continues until V2 receptors are down regulated (vasopressin escape) [5]. There are multiple etiological factors as mentioned earlier cause inappropriate ADH secretion. A Schwartz criterion is used for diagnosing SIADH which is mentioned below: Diagnostic Criteria for SIADH:Schwartz diagnostic criteria [5,13] ESSENTIAL CRITERIA  Decreasing measured serum…show more content…
ACEI causes hyponatremia by blocking the conversion of angiotensin I to angiotensin II in the peripheral circulation but not in the brain where angiotensin I gets converted to angiotensin II [16]. Angiotensin II is known to stimulate the release of ADH resulting in hyponatremia [18]. Angiotensin II type I receptor blocker causes hyponatremia by blocking the effects of aldosterone resulting in hyponatremia when combined with thiazides causes severe hyponatremia [17 ] . APPROACH TO A PATIENT WITH HYPONATREMIA [5,19]  Assess for the severity of symptoms  Duration of the symptoms  Check for the volume status  Assess for the causes of hyponatremia such as drug history  Do the necessary investigations such as serum & urine osmolality, urine spot sodium, thyroid function test and serum cortisol levels. PRINCIPLES OF SODIUM CORRECTION The treatment of hyponatremia depends upon  Severity of symptoms  Duration of hyponatremia(acute or chronic)  Cause of
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