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LETTER TO THE EDITOR
Year : 2012  |  Volume : 16  |  Issue : 1  |  Page : 148-149

Syndrome of inappropriate antidiuresis


Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt, India

Date of Web Publication26-Dec-2011

Correspondence Address:
M K Garg
Department of Endocrinology, Army Hospital (Research and Referral), Delhi Cantt - 110010
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.91218

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How to cite this article:
Kharb S, Garg M K. Syndrome of inappropriate antidiuresis. Indian J Endocr Metab 2012;16:148-9

How to cite this URL:
Kharb S, Garg M K. Syndrome of inappropriate antidiuresis. Indian J Endocr Metab [serial online] 2012 [cited 2021 Mar 7];16:148-9. Available from: https://www.ijem.in/text.asp?2012/16/1/148/91218

Sir,

In their review article "Syndrome of inappropriate anti diuretic hormone secretion: Revisiting a classical endocrine disorder," [1] the authors have covered the topic very lucidly. However, we feel that one common and very pertinent cause of SIADH, more so in a Third World country like India, is tuberculosis which can cause SIADH by its pulmonary, central nervous system as well as miliary inflictions. [2] Also, in primary and secondary level hospital settings where serum and urinary osmolality measurement facilities are not available, supplemental criteria may also be used to suggest diagnosis of SIADH, which include the following:

  1. Plasma uric acid < 4 mg/dl
  2. Blood urea nitrogen < 10 mg/dl
  3. Fractional sodium excretion > 1%; fractional urea excretion > 55%
  4. Failure to correct hyponatremia after 0.9% saline infusion
  5. Correction of hyponatremia through fluid restriction
  6. Abnormal result on test of water load (<80% excretion of 20 ml of water per kilogram of body weight over a period of 4 hours), or inadequate urinary dilution (specific gravity < 1.010)
  7. Elevated plasma AVP levels, despite the presence of hypotonicity and clinical euvolemia. [3]


Also, regarding management, a simple way of sodium replacement is to start 3% saline infusion at 1-2 ml/kg body weight per hour for acute severe symptomatic hyponatremia and at half the rate for chronic hyponatremia. Measure the serum sodium after 2 hours and adjust the rate to achieve desired correction of 8-12 mmol/l in 24 hours. We have successfully treated an elderly patient of severe symptomatic hyponatremia with very low serum sodium (98 mmol/l) using the above method, which is least cumbersome, easy to remember and devoid of much calculations. [4]

 
   References Top

1.Pillai BP, Unnikrishnan AG, Pavithran PV. Syndrome of Inappropriate Anti Diuretic Hormone secretion: Revisiting a classical endocrine disorder. Indian J Endocrinol Metab 2011;15 Suppl 3:208-15.  Back to cited text no. 1
    
2.Arya V. Endocrine manifestations of tuberculosis. Int J Diabetes Dev Ctries 1999;19:71-7.  Back to cited text no. 2
    
3.Ellison DH, Berl T. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med 2007;356:2064-72.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Garg MK, Nair V, Kumar N. Severe symptomatic diuretic induced hyponatremia. MJAFI 2010;66:198.  Back to cited text no. 4
    




 

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