SIADH LÀ GÌ

     
James L. Lewis III

, MD, Brookwood Baptist Health & Saint Vincent’s Ascension Health, Birmingham




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Hyponatremia reflects an excess of total toàn thân water (TBW) relative lớn total toàn thân sodium content. Because total body sodium content is reflected by extracellular fluid (ECF) volume status, hyponatremia must be considered along with status of the ECF volume: hypovolemia, euvolemia, and hypervolemia (see table Principal Causes of Hyponatremia Principal Causes of Hyponatremia

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). Note that the ECF volume is not the same as effective plasma volume. For example, decreased effective plasma volume may occur with decreased ECF volume (as with diuretic use or hemorrhagic shock Shock Shock is a state of organ hypoperfusion with resultant cellular dysfunction & death. Mechanisms may involve decreased circulating volume, decreased cardiac output, and vasodilation, sometimes... read more ), but it may also occur with an increased ECF volume (eg, in heart failure Heart Failure (HF) Heart failure (HF) is a syndrome of ventricular dysfunction. Left ventricular failure causes shortness of breath and fatigue, and right ventricular failure causes peripheral và abdominal fluid... read more
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, hypoalbuminemia, or capillary leak syndrome).





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Extrarenal fluid losses, such as those that occur with the losses of sodium-containing fluids as in protracted vomiting, severe diarrhea, or sequestration of fluids in a 3rd space (see table Composition of body Fluids Composition of body Fluids

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), can cause hyponatremia typically when losses are replaced by ingesting plain water or liquids low in sodium (see table Approximate Sodium content Approximate Sodium content of Common Beverages
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) or by hypotonic IV fluid. Significant ECF fluid losses also cause release of vasopressin, causing water retention by the kidneys, which can maintain or worsen hyponatremia. In extrarenal causes of hypovolemia, because the normal renal response to lớn volume loss is sodium conservation, urine sodium concentration is typically < 10 mEq/L (



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