Physiologie du mourir: scrtion accrue dADH en fin de vie

Resume Nous montrons pourquoi une secretion accrue d’hormone antidiuretique (ADH), et souvent un syndrome de secretion inappropriee d’ADH (SIADH) asymptomatique, est present chez les malades en fin de vie, surtout chez les patients souffrant de cancer terminal. Cette situation est en partie reliee a l’evolution de la maladie et en partie due aux medicaments utilises pour maintenir le confort. Elle est normalement peu symptomatique car les malades en fin de vie restreignent spontanement leurs apports liquidiens. Cependant cela entraine parfois une retention inappropriee d’eau si les liquides ingeres ou metaboliquement produits sont accrus causant une expansion secondaire des compartiments liquidiens corporels. Cela peut exagerer plusieurs sources d’inconfort chez le malade et mener a l’apparition de râles terminaux. Nous pensons qu’une meilleure comprehension de ce probleme permet d’adopter des comportements therapeutiques prudents et facilite les interactions avec les familles inquietes des soins apportes a leur proche.

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