Page 213 - Critical Care Notes

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■ Lethargy
■ Agitation and confusion
Diagnostic Tests
■ Blood cultures
■ Urine cultures and urinalysis
■ CBC with differential
■ PT/PTT
Management
■ Administer broad-spectrum antibiotics until organism identified.
■ Support BP with vasopressors, such as vasopressin, Levophed, and
dopamine.
■ Administer IV fluids.
■ Provide emotional support to patient and family members.
■ Also refer to Multisystem Tab.
Disseminated Intravascular Coagulation (DIC)
See DIC as previously discussed.
Syndrome of Inappropriate Antidiuretic Hormone
(SIADH)
SIADH is caused by malignant tumors, usually small cell lung cancer, tumors of
the head and neck, tumors of the pancreas, and urological and gastric malignan-
cies, that produce or secrete ADH or tumors that stimulate the brain to make and
secrete ADH. SIADH can also be caused by medications frequently used by
patients with cancer (e.g., morphine, cyclophosphamide) and by chemotherapy
agents such as cisplatin, cyclophosphamide, imatinib, vinorelbine, alemtuzumab,
ifosfamide, vincristine, and morphine. In SIADH, an excessive amount of water
is reabsorbed by the kidney → ↑ in excessive fluid in circulation → hyponatremia
and fluid retention.
Thoracic or mediastinal tumors can cause compression of major blood
vessels →↓→ fluid volume stimulation of the brain to secrete ADH, which can lead
to ↓ urinary output.
The clinical presentation, diagnostic tests, and management of SIADH are
discussed in the Endocrine Tab.
Management
■ Radiation or chemotherapy may be given to ↓ tumor progression and cause
SIADH to subside and a return to normal ADH production.

HEMA/
ONCO