Fluid and Electrolyte Balance: ADH and Diabetes Insipidus

Flashcards reviewing ADH, diabetes insipidus, fluid volume imbalances, and IV fluids.

In fluid volume excess, will blood become more concentrated or dilute?

Dilute

If kidneys are working well and the body is in fluid volume excess, what will the body do to compensate?

Excrete the excess water through diuresis.

In a fluid volume excess with dilute blood, what will the urine be like?

Dilute

In dehydration with concentrated blood, what will the urine be like?

Concentrated

In SIADH, what happens to the blood's concentration?

The blood becomes dilute due to excessive water retention.

In SIADH, what happens to urine output and concentration?

Urine output decreases, and the urine becomes very concentrated.

In diabetes insipidus (DI), what is the primary loss?

Water

What is the number one concern with diabetes insipidus (DI)?

Shock

In diabetes insipidus (DI), what happens to the blood's concentration?

The blood becomes concentrated due to water loss.

In diabetes insipidus (DI), what happens to the urine's concentration?

The urine becomes dilute due to excessive water loss.

Where does ADH live?

Pituitary

What are some keywords that might indicate a potential ADH problem?

Craniotomy, head injury, sinus surgery, transsphenoidal hypophysectomy, increased intracranial pressure

If a patient had recent sinus surgery and is now producing 1,800 cc's of urine after voiding, what might you suspect?

Diabetes Insipidus, or a potential ADH problem.

What are signs and symptoms of fluid volume excess?

Distended neck veins, peripheral edema, increased CVP, wet lung sounds, polyuria (if kidneys working), bounding pulse, increased blood pressure, weight gain.

When assessing lung sounds, is it best to listen anteriorly or posteriorly?

Posteriorly because it is the best place.

What occurs during an acute gain or loss of weight?

Fluid gain or loss.

In fluid volume excess, are diuretics needed?

Yes, diuretics are needed to get rid of that fluid

What electrolyte should you worried about losing when on loop diuretic or thiazide?

Potassium

Bed rest induces what?

Diuresis because when supine, you perfuse your kidneys more

What are some causes hypovolemia?

Thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage or NG tube to suction.

What is third spacing?

When fluid is in a place that does you no good, no longer in the vascular space.

In diabetes, there is a large amount of what in the vascular space?

Sugar particles.

Having too many particles in the bloodstream can lead to PID, what is PID?

Particle induced diuresis

As a diabetic who also produces a lot of urine to excrete sugar particles, do they have low or high vascular volume?

Low vascular volume

What are signs and symptoms of hypovolemia?

Weight loss, decreased skin turgor, dry mucous membranes, decreased urine output, decreased blood pressure, increased pulse, weak & thready pulse, decreased CVP, small peripheral veins & neck veins, cool extremities, concentrated urine.

How do Isotonic IV fluids work?

They go in the vascular space & stay there.

What are some examples of isotonic solutions?

Normal saline, LR, D5W

How do hypotonic IV fluids work?

They go in, hang out, rehydrate, & move into the cell for cellular metabolism and won't drive up blood pressure.

What should one think of when they see the word hypertonic?

Packed with particles