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326 Exam 3 (Cardiology,GI,Endocrine) > ADH > Flashcards

ADH Flashcards

1
Q

Antidiuretic Hormone

A

Too high: SADH

Too Low: Diabetes Insipidus

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2
Q

SIADH

A

Symptom of inappropriate Antidiuretic Hormone

-An abnormal production or sustained secretion of ADH

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3
Q

SIADH is characterized by

A
  • Fluid retention
  • Serum hypoosmolality and hyponatremia (dilutional)
  • Concentrated urine
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4
Q

SIADH Etiology

A

Malignant Tumors
-small cell carcinoma of lung

Central Nervous System Disorders
-head trauma, stroke, brain tumors

Drug Therapy
-morphine, SSRIs, chemo

Other conditions
-Hypothyroidism, infection

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5
Q

SIADH: Pathogenesis

A
  1. Increased ADH
  2. Increased water reabsorption in renal tubules (w/o Na+)
  3. Increased intravascular fluid volume
  4. Dilutional hyponatremia and decreased serum osmolality
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6
Q

SIADH Osmolality

A

Serum Osmolality: LOW

Urine Osmolality + Specific gravity: HIGH

Serum Sodium: LOW

Urine Output: LOW

Weight: GAIN

**patient is retaining pure water without salt

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7
Q

Clinical Manifestations of SIADH depend on

A

Severity and rate of onset of hyponatremia

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8
Q

Sx of Hyponatremia

A

Dyspnea, Fatigue

Neuro: confusion, lethargy, muscle twitching, convulsions, dulled sensorium

GI: impaired taste, anorexia, vomiting, cramps

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9
Q

Severe Symptoms of Hyponatremia occur at

A

<100-115 mEq/L (135-145)

Possible irreversible neurologic damage

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10
Q

Water intoxication

A

Sodium levels outside of cell become so low that water enters cell to follow salt, causing cell to burst.

Brain cell swelling is lethal

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11
Q

Pharmacotherapy for SIADH

A

NOT the first line of treatment.

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12
Q

What is treatment for SIADH?

A

Directed at the underlying cause (discontinue offending medication)

-Hypertonic saline used sometimes

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13
Q

Chronic SIADH drug

A

Demeclocycline (Declomycin)

-ex) lung cancer

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14
Q

Demeclocycline: class

A

Tetracycline broad-spectrum antibiotic

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15
Q

Demeclocycline: USE

A

Antibiotic therapy

Treatment of SIADH

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16
Q

Demeclocycline: MOA

A

Interferes w/renal response to ADH

17
Q

Demeclocycline: AE

A

Photosensitivity
Teeth staining
Nephrotoxic

18
Q

Diabetes Insipidus (DI)

A

A deficiency of ADH or a decreased renal response to ADH

19
Q

DI is characterized by

A

Excessive loss of water in urine

20
Q

2 forms of Diabetes Insipidus

A
  1. Neurogenic (Central)
    - lesion in brain
  2. Nephrogenic
    - kidneys don’t respond
21
Q

Neurogenic DI Cause (not injuries)

A

Hypothalamus or pituitary gland damage

22
Q

Neurogenic DI associated disorders

A

Stoke
TBI
Brain surgery
Cerebral Infections

23
Q

Neurogenic DI: Onset

A

Sudden (following injury)

24
Q

Is Neurogenic DI permanent?

A

Usually YES

25
Q

Nephrogenic DI: Cause

A

Renal Origin

Loss of kidney function
Often drug-related (lithium)

26
Q

Associated disorders of Nephrogenic DI

A

CKD

27
Q

Onset of nephrogenic DI

A

Slow

Course: Progressive

28
Q

DI: pathogenesis

A
  1. Decreased ADH
  2. Decreased water reabsorption in renal tubules
  3. Decreased intravascular fluid volume
    4a. Increased serum osmolality (hypernatremia)
    AND
    4b. Excessive urine output
29
Q

Diabetes Insipidus: Osmolality

A

Serum osmolality: HIGH

Urine Osmolality and specific gravity: LOW

Serum sodium: HIGH

Urine Output; HIGH

Weight: LOSS

30
Q

DI Symptoms

A

-Polyuria
-Polydipsia
-Dehydration
-Others based on severity
(electrolyte imbalances)
(hypovolemic shock: Death)

31
Q

Neurogenic DI Pharmacotherapy

A

Synthetic ADH replacement

32
Q

Nephrogenic DI

A

Thiazide diuretics
-seems strange but has paradoxical effect of decreasing polyuria and increases urine osmolality
(No one knows why)

33
Q

Desmopressin (DDAVP): MOA

A

Synthetic ADH replacement therapy

-Antidiuretic effects

34
Q

Desmopressin (DDAVP): Route

A

Nasal Spray (Burns), PO, IV, SQ

35
Q

Desmopressin (DDAVP): AE

A

Small doses: none

Nasal spray: irritation

Large doses:

  • hyponatremia (dilutional from Inc ADH)
  • water intoxication (retaining water)
36
Q

DI Acronym: D-I-L-U-T-E

A 
Dry
I&O, Daily weight
Low specific gravity
Urinates lots 
Treat: vasopressin (desmopressin)
rEhydrate

326 Exam 3 (Cardiology,GI,Endocrine) (19 decks)

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