MEDizzy - A client has developed syndrome of inappropriate

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Endocrine Management

A client has developed syndrome of inappropriate antidiuretic hormone (SIADH) secondary to a pituitary tumor. The client’s symptoms include thirst, weight gain, and fatigue. The client’s serum sodium is 127 mEq/L. Which physician order should the nurse anticipate when treating SIADH?

ExplanationIf symptoms are mild and serum sodium is greater than 125 mEq/L (125 mmol/L), treatment includes the restriction of fluid to 800 to 1,000 mL per day and discontinuation of medications that stimulate the release of antidiuretic hormone (ADH). The fluid restriction should result in a progressive rise in serum sodium concentration and osmolality and symptomatic improvement. Normal serum sodium levels are 136 to 146 mEq/L. The bed should be positioned flat or with no more than 10 degrees of elevation to enhance venous return to the heart and increase left atrial filling pressure, reducing ADH release. Vasopressin is an antidiuretic hormone, thus it will aggravate the client’s problem. Hypertonic saline (3% to 5%) should be administered if the hyponatremia is severe (less than 120 mEq/L). Hypertonic solutions cause fluid to be drawn into the vascular system.