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Syndrome of Inappropriate ADH Secretion (SIADH)
https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/syndrome-of-inappropriate-adh-secretion-siadh
The syndrome of inappropriate ADH (vasopressin) secretion is defined as less than maximally dilute urine in the presence of serum hypo-osmolality, in patients with normal adrenal, thyroid, renal, hepatic, and cardiac function who do not have hypotension, volume depletion, or other physiologic causes of vasopressin secretion. SIADH is associated with myriad disorders.
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Diagnostic value of urine sodium concentration in hyponatremia …
https://pubmed.ncbi.nlm.nih.gov/21218377/
Results: The urine sodium value of 50 mEq/L was the most accurate in separating SIADH from hypovolemic hyponatremia: sensitivity 0.89, specificity 0.69, and accuracy 0.82. The diagnostic utility for SIADH versus hypovolemia, as quantified by the areas under the ROC curves, was not statistically different between urine sodium alone (0.89, 95% CI 0.77-0.96) and urine sodium …
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Syndrome of Inappropriate Antidiuretic Hormone Secretion
https://www.ncbi.nlm.nih.gov/books/NBK507777/
Serum sodium less than 135mEq/L Serum osmolality less than 275 mOsm/kg Urine sodium greater than 40 mEq/L (due to ADH-mediated free water absorption from renal collecting tubules) Urine osmolality greater than 100 mOsm/kg The absence of clinical evidence of volume depletion - normal skin turgor, blood pressure within the reference range
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Clinical Laboratory Evaluation of the Syndrome of Inappropriate
https://cjasn.asnjournals.org/content/3/4/1175
Urine biology can also be helpful in diagnosis of SIADH because patients with SIADH have high urine sodium (Na; >30 mEq/L), and most of them will have a high fractional excretion of Na (>0.5% in 70% of cases), reflecting salt intake. Conversely, low urine Na in patients with SIADH and poor alimentation is not rare.
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UpToDate
https://www.uptodate.com/contents/pathophysiology-and-etiology-of-the-syndrome-of-inappropriate-antidiuretic-hormone-secretion-siadh
The SIADH should be suspected in any patient with hyponatremia, hypoosmolality, and a urine osmolality above 100 mosmol/kg. In SIADH, the urine sodium concentration is usually above 40 mEq/L, the serum potassium concentration is normal, there is no acid-base disturbance, and the serum uric acid concentration is frequently low [ 1 ].
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Laboratory Investigation of SIADH - Laboratory Medicine
https://www.flandershealth.us/laboratory-medicine/laboratory-investigation-of-siadh.html
Total urine output is also measured. Normally, the plasma osmolality should drop by >5 mOsm/kg, and urine osmolality should drop to <100 mOsm/kg, with 90% or more of the water load excreted in 4 hours. In SIADH, there is less then 90% excretion of the water load and urine osmolality will consistently be greater then 100 mOsm/kg.
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Measurement of urinary creatinine in chronic SIADH can be used …
https://academic.oup.com/ndt/article/36/8/1551/6192814
In the syndrome of inappropriate antidiuretic hormone secretion (SIADH) , a low urinary solute intake decreases urine volume, making patients more susceptible to hyponatraemia [ 1, 2 ]. In a previous study, we showed that patients with SIADH commonly have a low solute output [ 2 ]. However, urine creatinine excretion was not determined in most of our patients [ 2 ].
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How to diagnose SIADH - Simple and Practical Mental Health
https://simpleandpractical.com/siadh-diagnosis/
The urinary sodium concentration in SIADH is increased to more than 20 or 30 mmol/L while the patient is on normal salt and water intake (Verbalis et al., 2013). What will we find in a person with polydipsia? If the person is drinking excessive amounts of fluids, e.g., in psychogenic polydipsia, the urine will be dilute.
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Hyponatremia - EMCrit Project
https://emcrit.org/ibcc/hyponatremia/
High urine sodium (>40 mEq/L) suggests: Euvolemic hyponatremia (SIADH, hypothyroidism, or adrenal insufficiency). Hypovolemic hyponatremia due to renal salt wasting (e.g. diuretics, vomiting, or cerebral salt wasting). isotonic fluid challenge (back to contents) This is not generally recommended (because it may make matters worse).
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Endocrine testing for the Syndrome of Inappropriate Antidiuretic
https://www.ncbi.nlm.nih.gov/books/NBK279055/
In patients with SIADH, the expected urine amount within 4 hours is reduced to 30-40%. However, the test involves a massive water intake in a short period of time and, therefore, is not considered a safe procedure for the majority of patients for the following three reasons: In SIADH patients, a relative intravascular overhydration will be enhanced
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