Differentiate SIADH from Diabetes Insipidus wherein both exhibit abnormalities in ADH

physiology.

Due to lack of antidiuretic hormone, the kidneys excrete large amounts of dilute urine (a
disorder referred to as diabetes insipidus), causing dehydration and increased concentration of
sodium chloride in the extracellular fluid. Increased plasma sodium concentration, which also causes
increased osmolarity, can be due to either loss of water from the extracellular fluid, which
concentrates the sodium ions, or excess sodium in the extracellular fluid. When there is primary loss of
water from the extracellular fluid, this results in hyperosmotic dehydration. This condition can occur
from an inability to secrete antidiuretic hormone, which is needed for the kidneys to conserve water.
This forces frequent urination and requires the individual to drink equally large volumes of water to
prevent collapse from volume depletion and hyperosmolality.

Syndrome of Inappropriate ADH (SIADH) – a clinical syndrome of inappropriately high ADH

levels which result in plasma hypoosmolality. SIADH consists of hyponatremia, inappropriately
elevated urine osmolality (>200 mOsm/kg), excessive urine sodium (UNa >30 mEq/L), and decreased
plasma osmolality. The inappropriately elevated level of ADH enhances the reabsorption of water, thus
concentrating the urine. It is the excess free water absorption that causes hyponatremia E.g. In
patients with severe congestive heart failure, increased secretion of ADH may be stimulated by a low
effective circulating pressure and volume. The ADH causes water retention, which simultaneously
causes or worsens edema and leads to a dilutional hyponatremia.

What is the mechanism of mannitol, an osmotic diuretic, in increasing the output?

Mannitol is a non-reabsorbable polysaccharide that acts as an osmotic diuretic. It inhibits water and
solulte reabsorption by increasing osmolarity of tubular fluid in the proximal tubules and more
importantly in the loop of Henle. In contrast to other diuretics, mannitol causes diuresis in which water
is lost in excess of Na+ and K+. Since mannitol is not readily absorbed by the renal tubules, it causes a
marked increase in the concentration of osmotically active molecules in the tubules. The osmotic
pressure of this solute then greatly reduces water reabsorption, flushing large amounts of tubular fluid
into the urine.

References:

Textbook of Medical Physiology by Guyton and Hall

http://emedicine.medscape.com/article/768380-overview