miércoles, 28 de noviembre de 2012

secrecion inadecuada de adh e insuficiencia cardiaca


Acude paciente de 84 años con diagnostico de Secrecion inadecuada de
ADH y con Insuficiencia cardiaca que me comenta que ha tenido varias
crisis de hiponatremia y que la ultima vez en urgencias se lo
corrigieron demasiado rapido y se puso muy malita.
Adjunto protocolo que puede ser de interes para sobretodo urgencias y
nuestros resis.
Me comenta que el exceso de sodio que le dan le sube la tension y
empeora su insuficiencia cardiaca.

Pregunta Pico en pacientes con Insuficiencia cardiaca con SIADH cual
es el tratamiento mas eficaz.



Eur J Clin Pharmacol. 2011 Apr;67(4):333-46. Epub 2011 Feb 17.
Arginine vasopressin (AVP) and treatment with arginine vasopressin
receptor antagonists (vaptans) in congestive heart failure, liver
cirrhosis and syndrome of inappropriate antidiuretic hormone secretion
Gassanov N, Semmo N, Semmo M, Nia AM, Fuhr U, Er F.
Department of Internal Medicine III, University of Cologne, Kerpener
Str. 62, 50937, Cologne, Germany.
Arginine vasopressin (AVP) is the major physiological regulator of
renal water excretion and blood volume. The AVP pathways of
V(1a)R-mediated vasoconstriction and V(2)R-induced water retention
represent a potentially attractive target of therapy for edematous
diseases. Experimental and clinical evidence suggests beneficial
effects of AVP receptor antagonists by increasing free water excretion
and serum sodium levels. This review provides an update on the
therapeutic implication of newly developed AVP receptor antagonists in
respective disorders, such as chronic heart failure, liver cirrhosis
and syndrome of inappropriate antidiuretic hormone secretion.

Congest Heart Fail. 2010 Jul;16 Suppl 1:S15-8.
Treatment options for hyponatremia in heart failure.
Goldsmith SR.
From the Hennepin County Medical Center, Minneapolis, Minnesota, and
the University of Minnesota, Minneapolis, MN 55415, USA.
Hyponatremia is independently associated with adverse outcomes in
patients with congestive heart failure (CHF). The primary cause of
hyponatremia in CHF is the inappropriate secretion of the antidiuretic
hormone arginine vasopressin (AVP). The binding of AVP to V(2)
receptors in the renal collecting duct promotes water retention, a
process that can lead to dilutional hyponatremia as well as increased
ventricular preload. Conventional treatment of hyponatremia in CHF is
largely based on water restriction, which is neither effective nor
well-tolerated. V(2)- and dual V(1a)/V(2)-receptor antagonists offer
physiologically based treatment for dilutional hyponatremia. Clinical
trials in patients with hyponatremia including those with CHF using
both selective and nonselective vasopressin antagonists have
demonstrated the effectiveness and safety of these agents in
correcting this common electrolyte abnormality.

Manuel Sánchez mollá
Cap El Raval. Elx

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