Syndrome of Inappropriate ADH Secretion Treatment

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Hello I'm a nursing student trying to figure out the treatment for SIADH. I'm reading that Furosemide (diuretic) and IV infusion of half normal saline (hypotonic solution) will decrease the circulatory volume and prevent sodium excretion. For some reason I can't wrap my head around how this will "prevent sodium excretion"... doesn't salt follow water? so if we are pushing fluid out of the body won't sodium follow? Please explain this to me because I'm stuck.

Thank you!

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Hi!

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Your thread was moved to nursing student assistance for best response.

You are fooling the body into dehydration which will "hold onto" the NA+.

Loop diuretics.... are often used in the treatment of hypervolemic hyponatremia. In patients with syndrome of inappropriate antidiuretic hormone secretion (SIADH) with euvolemic hyponatremia, diuretics are usually used in conjunction with normal saline to replenish the Na+ excreted with the diuresis.

Furosemide increases excretion of water by interfering with the Na+-K+-Cl- (Na-K-2Cl) transporter; that, in turn, results in inhibition of Na+ and Cl- reabsorption in the ascending loop of Henle. Na+ is reabsorbed more distally and the excreted urine is hypo-osmolar in relation to serum.

https://www.clinicalkey.com/topics/endocrinology/syndrome-of-inappropriate-antidiuretic-hormone-(siadh).html

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Thank you, that makes more sense now!

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Specializes in Pedi.

I've actually never seen a patient with SIADH on diuretics. Most of my SIADH patients were chronic related to brain tumors. They were treated with strict fluid restriction. Like I've seen patients on 480 mL per day fluid restrictions.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Which is the first line non aggressive treatment of SIADH. Correcting hyponatremia too rapidly may result in central pontine myelinolysis (CPM) with permanent neurologic deficits. It is important to remember that even severe hyponatremia can correct rapidly with just fluid restriction if that hyponatremia is associated with absent ADH secretion. Drug therapy is the last line of treatment with tumors as the tumor needs to be treated for effective treatment....and fluid restriction is the best treatment. The use Hypertonic 3%saline and lasix is for symptomatic hyponatremia and requires significant monitoring.

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