Page 232 - Critical Care Notes

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ENDO

Management
“Triangle of treatment”:
■ Decrease sympathetic outflow (Administer beta blockers: esmolol the drug
of choice. Calcium channel blockers may be administered if beta blockers
contraindicated).
■ Decrease production of thyroid hormone (Administer propylthiouracil
[PTU], methimazole [Tapazole], or radioactive iodine [Lugol’s iodine or
potassium iodide]).
■ Decrease peripheral conversion of T 4 to T 3 (PTU, beta blockers, and gluco-
corticoids such as hydrocortisone [Solu-Cortef]).
■ Assess neurological, respiratory, and cardiovascular status.
■ Monitor vital signs frequently.
■ Provide cooling measures for fever. Give acetaminophen; salicylates are
contraindicated.
■ Monitor for cardiac arrhythmias and signs of heart failure and cardiac
collapse.
■ Monitor ABGs and provide continuous SvO 2 monitoring. Administer O 2 or
ventilatory support as indicated.
■ Monitor serum glucose levels closely.
■ Administer IV fluids containing dextrose to replace liver glycogen.
■ Correct electrolyte imbalances.
■ Monitor intake and output.
■ Maintain a quiet environment.
Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)
SIADH is the continuous secretion of ADH from the pituitary gland despite low
osmolarity. It is frequently manifested by hyponatremia and water intoxication.
Oat cell lung cancer is the most common cause of SIADH.
Pathophysiology
Malignant tumors, pulmonary and CNS disorders, and select medications → ↑
secretion of ADH → hyponatremia → ↑ water retention → stimulation of renin-
angiotensin system → ↑ excretion of sodium in urine and excess of water.

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