Clinician Appreciation of the Syndrome of Inappropriate Antidiuretic Hormone
CCCF ePoster library. Shafiee M. Nov 2, 2016; 151005; 123
Dr. Mohammad Ali Shafiee
Dr. Mohammad Ali Shafiee
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Abstract
Rate & Comment (0)
#123

Topic: Survey or Interview (quantitative or qualitative)

Clinician Appreciation of the Syndrome of Inappropriate Antidiuretic Hormone


Shafiee, Mohammad Ali1; Sharif, Umar2; TabaTaba-Vakili, Sahar2; Parastandechehr, Gilda2; Hakimfaal, Shirin2; Nazarian, Amir; Dastgheib, Bijan2;

1Division of General Internal Medicine
 Assistant Professor, Department of Medicine, University of Toronto
 Royal College Mentor, Department of Medicine, University of Toronto
 Toronto General Hospital, 200 Elizabeth Street, 14 EN-208
 Toronto, ON, M5G 2C4 | Tel: 416-340-4800 ex 6244 | Fax: 416-595-5826

2Division of General Internal Medicine Toronto General Hospital
University Health Network
 Toronto General Hospital, 200 Elizabeth Street, 14 EN-209A
 Toronto, ON, M5G 2C4 | Tel: 416-340-4800 ex 2182 | Fax: 416-595-5826
 Division of Medicine, Toronto General Hospital, Toronto, Canada



Abstract:

Introduction:
Although many studies have been written on the management of hyponatremia and SIADH, clinician appraisal is often overlooked. The term SIADH has lead physicians to under appreciate the importance of the physiology of hyponatremia in these patients. The consequence of this is often under treatment, misdiagnosis and a lack of understanding of the mechanisms of the heterogeneous group of hyponatremic patients diagnosed as SIADH. Additionally, clinicians often do not appreciate the current therapeutic modalities for SIADH which include but are not limited to: water restriction, salt tablets, vaptans and many more. As treatment of SIADH can be challenging, clinicians can sometimes be limited in terms of the management options of hyponatremic patients who have been diagnosed with SIADH.
 
Objectives:
It is hypothesized that there is a knowledge gap in the underlying physiological factors of hyponatremia and SIADH as a common clinical dilemma among physicians. Furthermore, hyponatremic patients who are diagnosed as SIADH are not accurately assessed by clinicians leading to confusion in approach and therapeutics. 
 
Methods:
The total of 150 questionnaires with 25 multiple choice questions were distributed amongst Canadian undergraduates, post-graduate trainees in years 1 through 5, clinical fellows, general internal medicine staff and staff nephrologists at Toronto General Hospital (TGH). The research proposal was approved by Coordinated Approval Process for Clinical Research (CAPCR) at the University Health Network. The basic concept of questions was the physiological appraisal of hyponatremia and SIADH, clinicians’ diagnostic approach toward hyponatremia and SIADH, therapeutic approach and knowledge of modalities to treat hyponatremia, assessment of treatment in hospital setting, knowledge of significance of hyponatremia and participants level of training and a self-assessment.
 
Results:
119 out of 150 (79%) participated in the survey. Most participants (50%) had only undergraduate level of training. One quarter were in their first year of post graduate training followed by equal numbers being represented by fellows, senior post graduate trainees and staff. Self-appraisal questions showed that most physicians admitted to having deficiencies in diagnosis and treatment by rating their level of knowledge in diagnosis and treatment as either fair or good (40% and 30%, respectively). Diagnostic and treatment modalities consensus was mostly on water restriction (95%), stopping offending agent (50%) and treatment of underlying cause (60%). Significant variation was seen among physicians regarding diagnostic criteria for SIADH (10-25%) and majority failed to appreciate that most of the patients would be readmitted. Overwhelmingly, more than 50% of participants diagnosed SIADH regardless of the proposed criteria for SIADH other than clinical euvolemic hyponatremia.
 
Conclusion:
This survey signifies the evaluation of clinicians’ understanding of physiologic approach and management of hyponatremia in the hospital setting and contributes to filling the knowledge gap that could reduce length of hospital stay, readmission, cost of hospital stay as well as to reduce morbidity and mortality in hospitalized patients. Therefore, a holistic approach to teaching as well as to management is required to improve quality of care. 


References:
  1. Schwartz WB, Bennett W, Curelop S, Bartter FC. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of ADH. Am J Med 1957;23:529-42.
  2. Robertson GL. Regulation of AVP in the syndrome of inappropriate antidiuresis. Am J Med 2006;119: Sup 1:S36-42.
  3. Zahra Chitsazian,1 Batool Zamani,1,* and Maryam Mohagheghfar2, Prevalence of Hyponatremia in Intensive Care Unit Patients With Brain Injury in Kashan Shahid-Beheshti Hospital in 2012,  Arch Trauma Res. 2013 Aug; 2(2): 91–94.
  4. David H. Ellison, M.D., and Tomas Berl, M.D., The Syndrome of Inappropriate Antidiuresis, n engl j med 356;20
  5. Ewout J. Hoorn, Nils van der Lubbe and Robert Zietse, SIADH and hyponatraemia: why does it matter? NDT Plus (2009) 2 [Suppl 3]: iii5–iii11
  6. Robert Zietse, Nils van der Lubbe and Ewout J. Hoorn Current and future treatment options in SIADH, NDT Plus (2009) 2 (suppl 3): iii12-iii19
  7. Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FACP, FASN, Syndrome of Inappropriate Antidiuretic Hormone Secretion, emedicine Donal O’Donoghue1 and Anu Trehan,
  8. Halperin ML, Kamel KS, Oh MS. Mechanisms to concentrate the urine: an opinion. Curr Opin Nephrol Hypertens. 2008 Jul;17(4):416-22; http://www.endotext.org/neuroendo/neuroendo3b/neuroendo3b_4.htm
  9. M J Hannon and C J Thompson, The syndrome of inappropriate antidiuretic hormone:   prevalence, causes and consequences, European Journal of Endocrinology (2010) 162 S5–S12
  10. Diagnostic approach to a patient with hyponatraemia: traditional versus physiology-based options E.J. HOORN1, M.L. HALPERIN and R. ZIETSE
  11. Binu P. Pillai, Ambika Gopalakrishnan Unnikrishnan, and Praveen V. Pavithran Syndrome of inappropriate antidiuretic hormone secretion: Revisiting a classical endocrine disorder, Indian J Endocrinol Metab. 2011 September; 15(Suppl3): S208–S215
  12. S. Mahavir Agarwal and Aparna Agrawal, A comparative study of the clinico-aetiological profile of hyponatremia at presentation with that developing in the hospital Indian J Med Res. 2011 July; 134(1): 118–122.
  13. Donal O’Donoghue1 and Anu Trehan, SIADH and hyponatraemia: foreword NDT Plus(2009) [Suppl 3]: iii1–iii4, doi: 10.1093/ndtplus/sfp152
  14. Rose BD, Post TW. Clinical Physiology of Acid-Base and Electrolyte Disorders, 5th ed, McGraw-Hill, New York 2001. p.703
  15. C J Thompson, Hyponatraemia: new associations and new treatments, European Journal of Endocrinology (2010) 162 S1–S3
  16. Heinrich S, Wagner A, Gross P. Hyponatremia Med Klin Intensivmed Notfmed. 2013 Feb;108(1):53-8.
  17. Karen E. Yeates, Michael Singer, A. Ross Morton, Salt and water: a simple approach to hyponatremia, CMAJ • FEB. 3, 2004; 170 (3)


    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.


Save Settings