Nursing Pharmacology Chapter 26:  Renal Pharmacology

Management of inappropriate secretion of antidiuretic hormone

• Disease of impaired water excretion caused by inappropriate vasopressin secretion, resulting in:

  • Hyponatremia

  • Hypoosmolality

•   Clinical effects

  • Lethargy

  • Muscle cramps

  • Anorexia

  • Coma

  • Nausea

  • Convulsions

  • Vomiting

  • Death

• Clinical effects are seen only if excessive fluid intake (in oral or IV) occurs concurrently with inappropriate vasopressin secretion.

• Causes

  • Malignancies

  • Pulmonary disease

  •  CNS injury/diseases

    • Trauma

    • Infections

    • Tumors

  • Surgery

  • Drugs {cisplatin, Vinca alkaloids, cyclophosphamide (Cytoxan),chlorpropamide (Diabinese), thiazide diuretics, phenothiazines, carbamazepine (Tegretol), clofibrate, nicotine, narcotics, tricyclic antidepressants}

• Treatment

  • Water restriction

  • IV hypertonic saline

  • Loop diuretics

  • Drugs that reduce the ability of vasopressin to increase water permeability in the renal collecting ducts:  demeclocycline (Declomycin)

Jackson, E.K. Vasopressin and Other Agents Affecting the Renal Conservation of Water In, Goodman and Gillman's The Pharmacologial Basis of Therapeutics,(Hardman, J.G, Limbird, L.E, Molinoff, P.B., Ruddon, R.W, and Gilman, A.G.,eds) TheMcGraw-Hill Companies, Inc.,1996, pp.715-732.