ADH Disorders Flashcards
balances Na and water in body and controls water conservation
Antidiuretic Hormone
ADH is produced in the ? and secreted/stored by the ?
Hypothalamus
Posterior Pituitary Gland
The function of ADH is to cause the body to ? and ? blood vessels
Retain water
Constrict
Osmolarity: amount of ? in fluid (urine, blood)
Normal Serum Osmolarity: ?
Solute
270-295 mOsm/L
Serum Osmo above 295 mOsm/L = water deficit
- Concentration is too ? OR
- Water concentration is too ?
295 mOsm/L
Great
Little
Serum Osmo below 270 mOsm/L = water excess
- Amount of particles or solute is ? in proportion to the amount of water OR
- Too ? for the amount of solute
270 mOsm/L
Too Small
Much Water
renal tubule permeability to water is increased and water is reabsorbed
Presence of ADH
renal tubule permeability to water is decreased – renal excretion to fluids
Absence of ADH
Primary regulatory mechanism for the release of ADH
Plasma Osmolality
Persistent abnormally high (inappropriate) levels of
ADH in the absence of stimuli with normal renal function
SIADH
Feedback system is impaired and posterior pituitary
continues to release ADH
SIADH
Renal tubules continue to reabsorb free water regardless of the serum osmolality
SIADH
SIADH Causes
Lung problems (Pneumonia/Cancer)
Stroke, Gullian-Barre Syndrome
Damage to Hypothalamus
Drugs - Diabinese
SIADH CM: BP, RR
Hypertension
Tachycardia
SIADH CM: GI disturbance and Weight?
Anorexia
Gain
SIADH CM: Sodium Levels
Euvolemic Hyponatremia
SIADH CM: Neuro Status
Confusion (Brain Swelling)
Delirium
SIADH CM: Urine Output
Low with concentrated urine output
SIADH Management: Monitor?
Weight (Same time each day, Same clothes, Same scale)
I and O
HR and BP
SIADH Management: Frequent Neuro Assessment, ? Precautions
Mental Status and LOC
Seizures
SIADH Management: ? Restriction
Fluid
SIADH Pharmacotherapy: to remove the extra fluids through the kidneys…watch ? levels
Loop Diuretics (Lasix), K+
SIADH Pharmacotherapy: to remove fluid from the cell back into the vascular system so it can be urinated out (watch for causing fluid volume overload..give slowly and through central line per hospital protocol)
Hypertonic Solution (3% NSS)
SIADH Pharmacotherapy: inhibitor and allow for diuresis…don’t give with ? containing foods like milk or antacids because it affects absorption
Declomycin (Tetracyclin Family)
Calcium
Hyposecretion of ADH by the posterior pituitary gland caused by stroke, trauma, or surgery, or it may be idiopathic
Diabetes Insipidus
DI Patho: Inadequate secretion of ADH due to loss or malfunction of neurosecretory neurons that make up the posterior pituitary
Central/Neurogenic
DI Patho: Vasopressin Sensitive
Central/Neurogenic
DI Patho: Inadequate response by the kidneys to ADH.
A disorder of renal tubular function resulting in the
inability to respond to ADH in absorption of water.
Nephrogenic
DI Patho: Vasopressin Resistant
Nephrogenic
DI Patho: Suppression of ADH secondary a defect or damage to the thirst mechanism located in the hypothalamus resulting in increased fluid intake or psychogenic causes
Dipsogenic
DI CM: Excessive loss of water from body tissue and
imbalance of essential electrolytes (Na, K, Cl)
Dehydration
DI CM: excessive thirst, excessive amount of urine
Polydipsia, Polyuria 4L-24L per day ( >200 mLs)
DI CM: Urine diluted results to ?
Low Specific Gravity (1.001 - 1.005)
Serum Hyperosmolality
Hypernatremia
DI CM: Dry ? & ?, Decrease ?
Mucous membranes, Skin
Skin Tugor
DI CM: Extreme ? and muscle ?
Fatigue
Pain/Weakness
DI Management: Strict ?, daily ?, ?, watch other electrolytes ?
I and O
Weights
Safety
Hypokalemia
DI Management: Restrict foods that promote ? watermelon, grapes, garlic, berries etc and ? (tea, energy drinks, coffee)
Diuresis
Caffeine
DI Pharmacotherapy: Mild cases: ? used in type 2 diabetes…not used as much now but it has properties that increases ADH hormone…watch for ? (blood glucose) and educate patient about photo-sensitivity to the ? (mild)
Chlorpropamide (Diabinese)
Hypoglycemia
Sun
DI Pharmacotherapy: Extreme cases: ? (form of vasopressin that naturally occurs in the body which the ADH) also called ? …given PO, IV, nasally, or subq.
Side Effects: Watch for the patient to become ? too and ? intoxication
Desmopression
Stimate or DDAVP
Hyponatremic, Water
DI Pharmacotherapy: Maintain client intake of adequate fluids; IV ? may be prescribed to replace urinary losses
Hypotonic Saline
