Endocrine - Antidiuretic Hormones

Antidiuretic Hormones What it does?

• Produced in hypothalamus

• Stored in the posterior pituitary gland 

• Inhibit/reduce the urine output 

• Promote reabsorption of water in the collecting ducts of the kidney 

• When there is an increase in serum osmolarity, blood level/patient is hypovolemic (reduction in volume)

  • ADH is released to help promote the reabsorption/reduce urine output 

• ADH is made in the hypothalamus, stored in the posterior pituitary.

• It’s released when serum osmolality is high (too concentrated) or blood volume is low (hypovolemia).

• Its action is to hold onto water → ↓ urine output, ↑ reabsorption in the kidneys.

Antidiuretic Hormones (ADH) MOA

• Antidiuretic Hormone (ADH) produced by the posterior pituitary

• → Promotes ____reabsorption_____ of water within the kidney.

ADH Preparations 1

• Vasopressin

• Synthetic analogues of ADH​

ADH Preparations 2

• Desmopressin

• Synthetic analogues of ADH​

ADH Clinical Indications:

• Diabetes insipidus (high polyuria , loss lots of fluids)

• Nocturnal enuresis (bedwetting, reduce fluids but not treat condition)

• May also used in cardiac arrest to increase blood flow to the brain & heart (w/ Vasopressin)

  • By vasoconstriction 

ADH Contraindications and precaution

• Vasopressin in CAD; peripheral circulation_____________.

ADH AE

• Abdominal pain, transient headache, nasal congestion, nausea, rhinitis, facial flushing, water intoxication

• Excessive vasoconstriction w/ Vasopressin

• Monitor for WATER INTOXICATION – HA, drowsiness, restlessness, confusion, irritability, drowsiness, dyspnea, muscle weakness, N/V, bradycardia

Diabetes insipidus

• Deficiency of ADH

ADH Use with Diabetes Insipidus: CM

• ____polydipsia (excessive thirst)________________________,

• _____excretion of large volumes of dilute urine_______________________.

ADH Use with Diabetes Insipidus: Treatment

• ADH replacement

  • Desmopressin (agent of choice)

    • No vasoconstriction 

  • Vasopressin

Antidiuretic Hormone Interactions: Box 43-2 (p.851)

• Epinephrine, heparin, & phenytoin decrease the effects.

• Lithium carbonate may inhibit the effects.

• Carbamazepine, chlorpropamide and NSAIDs increase the effects

Antidiuretic Hormone Nursing Considerations: Box 43-3 (p.852)

• Monitor for fluid volume & electrolyte imbalances

• Assess s/s of water intoxication

• Monitor for exacerbation of vascular disease (vasopressin)

• Provide thorough patient teaching