Complications are significant and include water intoxication, cerebral edema, noncardiogenic pulmonary edema, heart failure, seizures, coma, and death Lippincott Advisor, a. The effect is reversed in diabetes insipidus. There are two types of DI: central also known as pituitary, neurogenic or neurohypophyseal and nephrogenic.
Without vasopressin, filtered water is excreted in the urine instead of being reabsorbed. In nephrogenic DI, ADH production and secretion are normal, but the kidneys are resistant to the anti-diuretic effects of the hormone. These conditions may be caused by damage to the hypothalamus or pituitary gland, central nervous system malformation, certain drugs, kidney diseases, and genetic defects. Major complications of DI include hypovolemia, hyperosmolality, circulatory collapse, CNS changes, loss of consciousness, bladder distention and hydronephrosis Lippincott Advisor, b.
For both conditions, be sure to closely monitor vital signs, intake and output, as well as daily weight. Assess urine and serum electrolyte levels, particularly sodium, and observe for changes in neurologic status and level of consciousness. For DI, also check the blood urea nitrogen level, urine specific gravity and osmolality, and the hour urine volume per your institution policies. Disclosure and Privacy Policy This website provides entertainment value only, not medical advice or nursing protocols.
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The patient will exhibit polydipsia, so this is where they have excessive thirst. And one way that I remember this symptom, if you look at the word diabetes insipidus, diabetes inSIPidus will make you want to SIP more water, because you're super thirsty. The urine, like we talked about, is going to be very dilute.
So the specific gravity of the urine will be very low, or under 1. Also the osmolarity of the urine will also be very low, because it's very dilute. So it will be under , and then we would expect kind of decreased sodium levels in the urine as well.
In the blood though, that's a totally different story. Because we're getting rid of all those fluids, the blood's going to be really concentrated, so the serum, or blood osmolarity is going to be over , and the sodium levels are also going to be really high, so we're going to see hypernatremia.
In terms of diagnosis of diabetes insipidus, we can do a water deprivation test to test the ability of the kidneys to concentrate urine. We can also do a vasopressin test. So vasopressin is essentially the same as ADH.
And if we give the patient vasopressin, we would expect their kidneys to reabsorb water. If their kidneys don't do that, then we know it's a problem with the kidneys and we have nephrogenic diabetes insipidus.
If we give the patient vasopressin and their kidneys do do their job and reabsorb water, then we know it was an issue with the pituitary gland not producing enough ADH.
And if that is the case, then we can provide medications such as vasopressin or desmopressin, which you can find on Pharm card [in our Pharmacology Flashcards ] in terms of getting more information about those medications. With SIADH, we have excess release of ADH from the posterior pituitary gland due to a brain tumor, head injury, meningitis, or because of a medication.
So even though the blood is very dilute, the posterior pituitary gland still releases ADH, even though it should not. So because it's releasing all this extra ADH inappropriately, it's causing the kidneys to reabsorb more water. And then we'll have signs and symptoms of fluid volume excess because we have all this extra fluid being reabsorbed. So the patient may exhibit signs and symptoms such as tachycardia, hypertension, crackles, jugular vein distention, as well as weight gain.
They may also complain of a headache, weakness, and muscle cramping. And then they may also exhibit confusion because we have hyponatremia due to all this dilution, and that can cause the patient to be confused.
So one way to remember what SIADH does, if you look at the first two letters of that, S-I, you can think of super inflated, and that's basically what happens. In terms of labs, we're going to have, basically, the exact opposite as we saw with diabetes insipidus. So the urine specific gravity will be elevated.
It will be over 1. The blood or the serum will be a completely different story. It will be very dilute, so the serum osmolality will be decreased. It will be under and we'll see hyponatremia because the sodium is diluted with all this extra fluid volume. In terms of treatment, we're definitely going to give the patient diuretics to try to get rid of some of this excess fluid.
We can also give them a vasopressin antagonist, and then we can also give them hypertonic saline to help bring up the sodium levels and allow for those electrolyte levels to be more in balance.
We're going to monitor for fluid volume excess. So if we have too much fluid volume overload, we can end up with pulmonary edema, which is life threatening. So we're definitely going to want to monitor for that. And then we're going to want to continually monitor the patient's neurologic status because of the confusion that can result from hypernatremia, and we're also going to need to implement seizure precautions, because hypernatremia can result in seizures if it gets too bad.
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The functions and components of the cerebrum, including coverage of the 4 lobes in the brain frontal, parietal, occipital, temporal.
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