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Diabetes Insipidus

Posterior pituitary disorders

What does diabetes insipidus result from? Diabetes insipidus results from a deficiency of ADH, which is secreted by the posterior lobe of the pituitary gland (neurohypophysis).
What does decreased ADH cause and what are the signs and symptoms? Decreased ADH reduces the ability of collecting and distal renal tubules in the kidneys to concentrate urine, resulting in excessive diluted urination, excessive thirst, and excessive fluid intake.
What are the 3 types of diabetes insipidus? Neurogenic, nephrogenic, and drug-induced
Neurogenic diabetes insipidus is caused by... Caused by damage to the hypothalamus or pituitary gland from trauma, irradiation, or cranial surgery.
Nephrogenic diabetes insipidus is caused by... It is inherited; renal tubules do not react to ADH
Drug-induced diabetes insipidus is caused by... Lithium carbonate or demeclocycline which may alter the way the kidneys respond to ADH.
What are the risk factors associated with diabetes insipidus? Head injury, tumor or lesion, surgery near the pituitary gland, infection, taking lithium or demeclocycline, and older adults.
What are the physical assessment findings regarding diabetes insipidus? Sunken eyes, tachycardia, hypotension, loss or absence of skin turgor, and dry mucous membranes.
The urine specific gravity will be? decreased (less than 1.005)
The urine osmolality will be? Decreased (less than 300 mOsm/L). As the urine volume increases the osmolality decreases.
The urine pH will be? Decreased
The urine sodium will be? Decreased
The urine potassium will be? Decreased
Urine chemistry will be? Dilute
Serum chemistry will be? Concentrated
The serum osmolality will be? Increased (greater than 300 mOsm/L). As serum volume decreases the serum osmolality will increase.
The serum sodium will be? Increased.
The serum potassium will be? Increased
The radioimmunoassay will show what lab value? Decreased ADH
What is an easy and reliable diagnostic test for diabetes insipidus? The water deprivation test. Dehydration is induced by withholding fluids. The urine out is measured and tested hourly. The kidneys will be unable to concentrate urine despite dehydration.
What is a complication of the water deprivation test and what is the nursing action if a complication occurs? Severe dehydration. The nurse should monitor for postural hypotension, tachycardia, and dizziness. Stop the test if this occurs.
What is the vasopressin test? A SQ injection of vasopressin. This produces urine output with an increased specific gravity if the pt has neurogenic DI. This differentiates neurogenic from nephrogenic.
What is the deciding factor for how much IV fluids are given? Output. The intake and output must be matched to prevent dehydration.
True or false. The pt may drink fluids in response to thirst. True
Name two ADH replacement medications desmopressin acetate (DDAVP) and aqueous vasopressin (Pitressins).
How can ADH replacements be administered? Intranasally, orally, or parentally.
While taking ADH replacements should the client restrict their fluids? Yes and they should be instructed to notify their provider if they develop a headache or confusion.
Name an ADH stimulant. Carbamazepine (Tegretol)- an anticonvulsant which stimulates the release of ADH.
Does the patient have to take Tegretol with regards to meals? Yes. The pt should take Tegretol with meals to reduce gastric distress.
What are the nursing consideration for Tegretol? Take with meals, monitor vitals, I&O, CVP, specific gravity, monitor labs, monitor for dizziness or drowsiness, and monitor for thrombocytopenia (sore throat, bruising, and fever).
What effect does vasopressin (Pitressin) have on the kidneys and urinary output? Vasopressin is a posterior pituitary hormone (ADH replacement) that causes an increase in water absorption from kidneys and a decrease in urine output.
What are the complication of DI? Hypovolemia, hyperosmolarity, hypernatremia, circulatory collapse, unconsciousness, CNS damage, and seizures.
Created by: rexp