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Criteria of Khan et al for the Isometric Syndrome (Masked SIADH Secretion Associated with Isotonic Saline Infusion Following Spinal Fusion Surgery)

Description

A patient undergoing spinal fusion surgery is at risk for transient syndrome of inappropriate antidiuretic hormone secretion (SIADH). The expected hyponatremia may be masked if the patient is receiving an infusion of normal saline. Khan et al listed criteria for recognizing this situation termed the isometric syndrome. The authors are from Presbyterian Hospital Albuquerque, University of Iowa and the University of Iowa Children's Hospital.


 

Patient selection: child or adult who has undergone spinal fusion surgery within 72 hours

 

Criteria for masked SIADH - all of the following:

(1) serum osmolality < 290 mOsm/kg

(2) urine osmolality > 600 mOsm/kg

(3) fractional excretion of sodium (FeNa) > 0.5

(4) urine output less than 0.5 mL per kg per hour

(5) urine sodium > 30 mEq/L (mmol/L)

(6) serum bicarbonate > 20 mEq/L (mmol/L)

(7) serum potassium > 3.5 mEq/L (mmol/L)

 

Hyponatremia (serum sodium < 135 mEq/L) was not used as a criterion. Measurement of serum ADH concentration was not used as a criterion.

 


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Specialty

ICD-10