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Topics:
General Internal Medicine • Nephrology • Hepatology • Oncology • Hospital Medicine • General Hospital Medicine
What is your approach to managing concurrent severe SIADH and large-volume malignant ascites when aggressive volume removal appears to exacerbate both symptoms and hyponatremia?
For example, would you consider alternatives to paracentesis (Denver shunt placement, CART therapy, or permanent tunneled catheters) that might better preserve volume status while managing the sodium imbalance?
Answer from: at Community Practice
A challenging situation. I would approach it in a few steps:
Ensure adequate solute intake since solute load determines free water clearance in SIADH. Loss of solute from repeated large-volume paracenteses can add a component of hypovolemic hyponatremia, and people with cancer and large ascites ten...
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