護理師照護一位抗利尿激素分泌不當症候群（SIADH）病人。護理師應執行哪項處置？
A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which intervention should the nurse implement?
- AAdminister synthetic vasopressin給藥合成血管加壓素
- BAdminister intravenous hypotonic saline給藥靜脈注射低張食鹽水
- CMaintain fluid restriction✓ 正解維持液體限制
- DEncourage increased fluid intake鼓勵增加液體攝取
抗利尿激素分泌不當症候群（Syndrome of Inappropriate Antidiuretic Hormone, SIADH）是一種內分泌紊亂，其特徵是垂體後葉過度分泌抗利尿激素（Antidiuretic Hormone, ADH），導致腎臟對水的再吸收增加。這會造成體內水分過度滯留，導致稀釋性低血鈉（dilutional hyponatremia）和血液滲透壓降低，但尿液滲透壓卻相對升高。病人可能會出現水腫、噁心、嘔吐、食慾不振，嚴重時甚至會出現意識改變、癲癇或昏迷。 SIADH 的主要病理生理學問題是水分過量，而非鈉離子絕對缺乏。因此，治療的關鍵在於限制液體攝取，以減少體內水分負荷，使血清鈉離子濃度逐漸恢復正常。嚴格的液體限制是首要且最有效的非藥物治療措施，能直接針對水分過量的問題，改善低血鈉狀態。
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is an endocrine disorder characterized by excessive secretion of antidiuretic hormone (ADH) from the posterior pituitary, leading to increased renal reabsorption of water. This causes excessive water retention, dilutional hyponatremia, and decreased serum osmolality, while urine osmolality is relatively elevated. The client may develop edema, nausea, vomiting, anorexia, and in severe cases altered mental status, seizures, or coma. The primary pathophysiologic problem in SIADH is water excess rather than absolute sodium deficiency. Therefore, treatment focuses on restricting fluid intake to reduce total body water, allowing serum sodium concentration to gradually return to normal. Strict fluid restriction is the first-line and most effective non-pharmacologic intervention; it directly addresses the underlying water overload and improves hyponatremia.
SIADH 的診斷和治療原則在台灣與美國是高度一致的。兩地臨床上都會將液體限制作為 SIADH 的首要治療策略。在藥物使用方面，美國可能會較早考慮使用血管加壓素受體拮抗劑（vasopressin receptor antagonists, 如 tolvaptan），而台灣可能在嚴重或頑固性病例中才會使用，並更強調電解質的監測與調整。但基本護理原則如監測體重、輸入輸出量、電解質和意識狀態，兩地並無顯著差異。