Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH): Optimal Management

Figures & data

Table 1 Causes of SIADH

Tumors Associated with SIADH	Infectious Diseases	Disorders of the Nervous System	Drugs	Other Causes
Respiratory tract:  lung,  oropharynx Gastrointestinal tract:  stomach,  duodenum,  pancreas Genitourinary tract:  endometrium,  ureter,  bladder,  prostate Other cancers:  sarcomas,  lymphomas,  thymoma, neuroblastoma	Pulmonary:  pulmonary abscess,  bacterial or viral pneumonia,  Tuberculosis,  Aspergillosis Nervous System:  brain abscess,  encephalitis,  meningitis,  AIDS,  Malaria,  Rocky mountain spotted fever	Vascular diseases:  subdural hematoma,  subarachnoid haemorrhage,  stroke,  cavernous sinus thrombosis Others:  brain tumors,  hydrocephalus,  head trauma,Multiple sclerosis,  Guillain–Barré syndrome,  Delirium tremens,  Acute intermittent porphyria	Antidepressant  SSRIs,  Tricyclic,  MAOI,  Venlafaxine Anticonvulsant Antipsychotics Anticancer Drugs  Vinca alkaloids,  Platinum compounds,  Ifosfamide,  Melphalan,  Cyclophosphamide,  Methotrexate,  Pentostatin,  Targeted therapies,  Immune checkpoint inhibitors Antidiabetic Drugs  Chlorpropamide,   Tolbutamide Others  Opiates,  MDMA,  Interferon,  Levamisole,  NSAIDs,  Clofibrate,  Nicotine,  Amiodarone,  PPI,  MABs Vasopressin Analogues  Desmopressin,  Oxytocin,  Terlipressin,  Vasopressin	Hereditary  Gain of function mutation of the V2R Idiopathic Transient Asthma Cystic fibrosis Respiratory failure associated with positive-pressure breathing General anaesthesia Nausea Pain Stress

Notes: Data from Spasovski et al.¹⁸

Abbreviations: AIDS, acquired immune deficiency syndrome; SSRIs, selective serotonin reuptake inhibitors; MAOI, monoamine oxidase inhibitors; MDMA, 3.4-methylenedioxymethamphetamine; NSAIDs, non-steroidal anti-inflammatory drugs; PPI, proton pump inhibitors; MABs, monoclonal antibodies.

Table 2 SIADH Diagnostic Criteria

Essential Criteria
Effective serum osmolality <275 mOsm/kg
Urine osmolality >100 mOsm/kg with decreased effective osmolality
Evidence of clinical euvolaemia
Increased urine sodium concentration >30 mmol/l with normal salt and water intake
Normal adrenal, thyroid, pituitary or renal function
No recent use of diuretic drugs
Auxiliary Criteria
Serum uric acid <0.24 mmol/l (<4 mg/dl)
Serum urea <3.6 mmol/l (<21.6 mg/dl)
Failure to correct hyponatraemia after 0.9% saline administration
Fractional sodium excretion >0.5%
Fractional urea excretion >55%
Fractional uric acid excretion >12%
Correction of hyponatraemia through fluid restriction

Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant. 2014;29(2):1–39.

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