How would you answer this question?
A patient with an antidiuretic hormone (ADH)-secreting small-cell cancer of the lung is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective upon finding that the:
a. patient's daily weight is stable.
b. urine specific gravity is increased.
c. patient's urinary output is increased.
d. peripheral edema is decreased.
The correct answer is "c" patient's urinary output is increased.
The syndrome of inappropriate anti-diuretic hormone (SIADH) is a condition where too much anti-diuretic hormone is released by the pituitary gland in the brain. Neurological dysfunction, such as a stroke or head injury, is the lost common etiology for SIADH. Less commonly, respiratory conditions such as mechanical ventilation or lung cancer can cause ADH to be secreted from lung tissue, leading to SIADH.
Excessive ADH secretion causes the kidneys to hold onto fluid (anti-diuretic) inappropriately leading to fluid retention, concentrated urine, and a low serum sodium -- a clustering of signs and symptoms that are not normally found together. Concentrated urine is usually found in dehydration and is associated with a high serum sodium.
Demeclocycline blocks the action of ADH on the renal tubules and increases urine output. A stable body weight and an increase in urine specific gravity indicate that the SIADH is not corrected. Peripheral edema does not occur with SIADH; a sudden weight gain without edema is a common clinical manifestation of this disorder.
Find out more about SIADH and Diabetes Insipidus by watching our video.
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Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.
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