Inappropriate antidiuretic hormone secretion: long-term successful urea treatment

2011 ◽  
Vol 101 (1) ◽  
pp. e39-e42 ◽  
Author(s):  
Hassib Chehade ◽  
Luigi Rosato ◽  
Eric Girardin ◽  
Francois Cachat
Author(s):  
Francisco-Javier Mena-Martín ◽  
Maria Gonzalez-Fernandez ◽  
Marina Cazorla-Gonzalez ◽  
Juan Carlos Martin-Escudero

Amyotrophic lateral sclerosis (ALS) rarely presents with hyponatraemia caused by syndrome of inappropriate antidiuretic hormone secretion (SIADH). We present a patient with hyponatraemia of multifactorial aetiology, in whom, after withdrawal of the drugs that contributed to this ionic alteration, SIADH secondary to ALS was confirmed. After initiating treatment with urea, sodium levels were normalized.


Author(s):  
Michael Dick ◽  
Sarah R Catford ◽  
Kavita Kumareswaran ◽  
Peter Shane Hamblin ◽  
Duncan J Topliss

Summary The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can occur following traumatic brain injury (TBI), but is usually transient. There are very few case reports describing chronic SIADH and all resolved within 12 months, except for one case complicated by meningo-encephalitis. Persistent symptomatic hyponatremia due to chronic SIADH was present for 4 years following a TBI in a previously well 32-year-old man. Hyponatremia consistent with SIADH initially occurred in the immediate period following a high-speed motorbike accident in 2010. There were associated complications of post-traumatic amnesia and mild cognitive deficits. Normalization of serum sodium was achieved initially with fluid restriction. However, this was not sustained and he subsequently required a permanent 1.2 l restriction to maintain near normal sodium levels. Multiple episodes of acute symptomatic hyponatremia requiring hospitalization occurred over the following years when he repeatedly stopped the fluid restriction. Given the ongoing nature of his hyponatremia and difficulties complying with strict fluid restriction, demeclocycline was commenced in 2014. Normal sodium levels without fluid restriction have been maintained for 6 months since starting demeclocycline. This case illustrates an important long-term effect of TBI, the challenges of complying with permanent fluid restrictions and the potential role of demeclocycline in patients with chronic hyponatremia due to SIADH. Learning points Hyponatraemia due to SIADH commonly occurs after TBI, but is usually mild and transient. Chronic hyponatraemia due to SIADH following TBI is a rare but important complication. It likely results from damage to the pituitary stalk or posterior pituitary causing inappropriate non-osmotic hypersecretion of ADH. First line management of SIADH is generally fluid restriction, but hypertonic saline may be required in severe cases. Adherence to long-term fluid restriction is challenging. Other options include oral urea, vasopressin receptor antagonists and demeclocycline. While effective, oral urea is poorly tolerated and vasopressin receptor antagonists are currently not licensed for use in Australia or the USA beyond 30 days due to insufficient long-term safety data and specific concerns of hepatotoxicity. Demeclocycline is an effective, well-tolerated and safe option for management of chronic hyponatraemia due to SIADH.


2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098565
Author(s):  
Cai-Fu Zhao ◽  
Su-Fen Zhao ◽  
Ze-Qing Du

Small cell carcinoma of the cervix is a rare malignant tumor in the clinical setting. Clinical manifestations of this tumor are mostly similar to those of normal types of cervical cancer. Small cell carcinoma of the cervix only shows symptoms of neuroendocrine tumors, such as syndrome of inappropriate antidiuretic hormone secretion (SIADH). Most of the hyponatremia caused by SIADH can be managed after removal of the cause. Hyponatremia is a predictor of poor prognosis and can be used as an indicator of partial recurrence. We report a case of small cell carcinoma of the cervix complicated by SIADH. Our patient presented with irregular vaginal bleeding after menopause. After one cycle of chemotherapy, there was trembling of the limbs, and a laboratory examination showed low Na+ and low Cl− levels. After limited water intake, intravenous hypertonic saline, and intermittent diuretic treatment, the patient’s blood Na+ levels returned to normal. After a radical operation, the above-mentioned symptoms disappeared.


2014 ◽  
Vol 2014 (apr11 1) ◽  
pp. bcr2013202575-bcr2013202575
Author(s):  
P. Barros Alcalde ◽  
A. Gonzalez Quintela ◽  
M. Pena Seijo ◽  
A. Pose-Reino

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