Physiologie du mourir : sécrétion accrue d'ADH en fin de vie

An increased secretion of ADH occurs frequently at the end of life. We show that a hypoalbuminemia often observed in cachectic patients causes a hyponatremia. Many other factors including a low sodium intake, nausea and vomiting, stress, pain, production of ADH by the tumor itself, and the ADH-secreting effect of the medication explain that a syndrome of inappropriate secretion of ADH frequently occurs in palliative patients. The patients however spontaneously restrict their water intake and this usually prevents the observation of a profound hyponatremia. Nevertheless, caution must be exercised when hydrating terminal patients by i.v., SC, oral or enteral routes. These concepts are useful to optimize the treatments given to patients in palliative care setting and for discussions of optimal treatments with their family.