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Diabetes Insipidus

QuestionAnswer
Core Problem Deficiency of ADH (Central) or renal resistance to ADH (Nephrogenic). Leads to inability to concentrate urine.
Key Etiologies Central: head trauma, surgery, tumors. Nephrogenic: lithium, demeclocycline, chronic kidney disease.
Sodium Level Hypernatremia (high serum sodium) due to excessive loss of free water in dilute urine.
Osmolality High serum osmolality (>295 mOsm/kg) because water loss concentrates particles in the blood.
Osmolality Low urine osmolality (<300 mOsm/kg) because kidneys cannot concentrate urine, excreting mostly water.
Specific Gravity Very low (<1.005) because urine is extremely dilute, like water.
Presentation "Dry Inside": Polyuria (3-20L/day), Polydipsia, signs of dehydration (tachycardia, hypotension).
Water Deprivation Tests body's ability to concentrate urine. Desmopressin given after to differentiate Central vs Nephrogenic.
Central vs Nephrogenic DI Test After water deprivation, urine concentrates with Desmopressin in Central DI, but not in Nephrogenic DI.
Central DI treat Desmopressin (DDAVP) - synthetic ADH. Given intranasally, orally, or IV. Monitor for water intoxication.
Nephrogenic DI treat Thiazide diuretics, NSAIDs (Indomethacin), low-sodium diet. Does NOT respond to Desmopressin.
I&Os Strict monitoring of intake and output. Daily weights to assess fluid balance and hydration status.
Severe Complication Hypovolemic Shock from profound dehydration. Signs: Tachycardia, tachypnea, weak pulses, low BP, altered LOC.
Caution Lithium A common cause of Nephrogenic DI. Monitor serum levels and renal function in patients on lithium.
Patient Safety High fall risk due to nocturia and potential for orthostatic hypotension from dehydration.
Fluid Replacement Encourage oral fluids to match output. IV hypotonic fluids (like 0.45% NaCl) may be needed for severe dehydration.
Not DM Patients have normal blood glucose. The polyuria is due to water, not glucose, loss.
Skin Care Dry skin and mucous membranes are common. Provide moisturizers and encourage frequent sips of water if allowed.
Long-term treatment Lifelong medication adherence (for Central DI), regular electrolyte checks, medical alert bracelet.
Created by: Wasurenboh
 

 



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