Peri Alessandro, Parenti Gabriele, Giuliani Anna, Scrivano Jacopo, Pettorini Laura, Festuccia Francescaromana, Pirozzi Nicola, Mene' Paolo
Dipartimento di Fisiopatologia Clinica, Universita' di Firenze, Firenze, Italy.
G Ital Nefrol. 2012 Nov-Dec;29(6):661-73.
The syndrome of inappropriate ADH secretion (SIADH), also termed ''syndrome of inappropriate antidiuresis (SIAD)'', is an often unrecognized cause of hypotonic hyponatremia, arising from ectopic release of ADH in lung cancer or as a side effect of various drugs. In SIADH, hyponatremia results from selectively impaired water excretion by the kidney, whereas the external Na+ balance is normally regulated. Despite the increase in total body water, only a slight reduction of urine output and modest edema are usually seen. Renal function and acid-base balance are generally preserved, while subclinical neurological impairment may occasionally become life-threatening, when hyponatremia has an abrupt onset. The major clinical variants of SIADH are reviewed here, with particular emphasis on causes, iatrogenic complications and hospital-acquired hyponatremia. Effective treatment of SIADH is based on water restriction, hypertonic saline plus loop diuretics, or aquaretics. Worsening of hyponatremia may result from parenteral isotonic fluid administration, emphasizing the importance of an early diagnosis and careful follow-up of these patients.
抗利尿激素分泌不当综合征（SIADH），也称为“抗利尿不当综合征（SIAD）”，是低渗性低钠血症的一个常被忽视的病因，源于肺癌中抗利尿激素的异位释放或各种药物的副作用。在SIADH中，低钠血症是由肾脏选择性地损害水排泄所致，而外部钠平衡通常是正常调节的。尽管总体水量增加，但通常仅见尿量略有减少和轻度水肿。肾功能和酸碱平衡一般得以保留，而当低钠血症突然发生时，亚临床神经功能损害偶尔可能危及生命。本文综述了SIADH的主要临床变体，特别强调病因、医源性并发症和医院获得性低钠血症。SIADH的有效治疗基于限水、高渗盐水加襻利尿剂或血管加压素受体拮抗剂。静脉输注等渗液体可能导致低钠血症恶化，这凸显了对这些患者进行早期诊断和密切随访的重要性。
