Paeds Vivas · endocrinology-diabetes-and-growth
SIADH and disorders of water balance — viva
Branching structured oral on SIADH and disorders of water balance in children, covering the ADH axis, the volume-status approach to hyponatraemia, hypertonic saline, cerebral salt wasting, and the sodium correction rate.
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"I am worried about hyponatraemic encephalopathy: he is drowsy and vomiting with a sodium that has dropped to 121 mmol/L on hypotonic-type fluids, so I will treat this as an emergency. I will assess his airway and conscious level, stop any hypotonic fluid, and prepare hypertonic 3 per cent saline. If he seizes or deteriorates I will give it aiming to raise the sodium by only 4 to 6 mmol/L, and I will call for senior and intensive care help. The likely mechanism is hospital-acquired hyponatraemia from an ADH stimulus plus free water." [7][6]
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- [1]Spasovski G; Vanholder R; Allolio B; et al Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant, 2014.PMID 24569496
- [3]Sterns RH Disorders of plasma sodium--causes, consequences, and correction. N Engl J Med, 2015.PMID 25551526
- [6]Moritz ML; Ayus JC Maintenance Intravenous Fluids in Acutely Ill Patients. N Engl J Med, 2015.PMID 26422725
- [7]Moritz ML; Ayus JC New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children. Pediatr Nephrol, 2010.PMID 19894066
- [8]Driano JE; Lteif AN; Creo AL Vasopressin-Dependent Disorders: What Is New in Children? Pediatrics, 2021.PMID 33795481
- [9]Bettinelli A; Longoni L; Tammaro F; et al Renal salt-wasting syndrome in children with intracranial disorders. Pediatr Nephrol, 2012.PMID 22237777
- [10]Sterns RH Adverse Consequences of Overly-Rapid Correction of Hyponatremia. Front Horm Res, 2019.PMID 32097948
- [12]Hoorn EJ; Zietse R Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines. J Am Soc Nephrol, 2017.PMID 28174217