Diabetes Insipidus (DI) & Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

Diabetes Insipidus is

-Disorder of the posterior lobe of the pituitary gland

-Deficiency of ADH (vasopressin)

etiology of DI

-Head trauma

-Brain tumor

-Surgical ablation of pituitary gland

-Failure of renal tubules to respond to ADH

-CNS infections

-Tumors

CM of DI

-Dilute, water-like urine

-Specific gravity decreases 1.001-1.005

-Intense thirst

-2-10 L cold water

specific gravity for DI urine

1.001-1.005

patients are so _____ due to water loss so they tend to want ______

-thirsty

-2-10 L cold water

Diagnostics for DI

-Fluid deprivation test

-Desmopressin trial

-Plasma ADH levels

-Plasma urine and serum osmolality

-IV hypotonic fluid

What happens to UO with DI

-INCREASED

-urine is very DILUTE

Medical Management for DI

-Replace ADH

-Ensure adequate fluid replacement (hypotonic fluid)

-Identify and correct underlying intracranial pathology

Pharmacologic Management

-VP

-IM or intranasal route

-Thiazide diuretics : cause fluid retention due to compensation

*Nephrogenic classification:

-Ibuprofen, Indocin, aspirin, thiazide diuretics and mild salt depletion

for nephrogenic DI meaning the kidney tubules do not respond to ADH what do we give

-Ibuprofen

-Indocin

-aspirin

-thiazide diuretics

-mild salt depletion

SERUM SODIUM DI is

120

-sodium is low because of the diuresis and also can be diluted due to hypotonic fluid

Normal specific gravity of urine

1.005-1.030

Nursing Management

-Patient and family education

-Administer medication

-Vasopressin causes vasoconstriction: monitor for CORONARY ARTERY DISEASE

-Educate s/s of hyponatremia

-Medical alert bracelet

when giving vasopressin for DI you must monitor for

monitor for CORONARY ARTERY DISEASE

what should you give a patient who has DI

medical alert bracelet

SIADH

-TOO MMUCH ADH

SIADH etiology

-Non-endocrine in nature

-Bronchogenic carcinoma

-Severe pneumonia

-Pneumothorax

-Malignant tumors

-Disorders of CNS

-Head injury

-Brain surgery/tumor

-Infection

non-endocrine SIADH etiology

-Bronchogenic carcinoma

-Severe pneumonia

-Pneumothorax

SIADH patho

Excessive ADH secretion from the pituitary gland even in the face of subnormal serum osmolality

clinical manifestation of SIADH

-Concentrated urine

-Retention of fluids

-Sodium deficiency (dilutional hyponatremia)

Management of SIADH

-Elimination of underlying cause

-Restrict fluid intake

-Diuretics (LASIX)

-Fluid restriction if severe hyponatremia is present

what must you monitor for patients with DI and SIADH

-Close monitoring of I/O, daily weight

SIADH vs. DI

HYPONATREMIA CM

1. lethargy

2. confusion

3. Decreased reflexes

4. seizures

5. coma

6. respiratory system: shallow breathing

7. rapid HR

8. increased urinary output

*Most life-threatening*:

6. Cerebral edema

7. Increased intracranial pressure

8.sluggish pupils

hypernatremia

-change in MS

-confused

-decreased urine output