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MS 2 > Anti-Diuretic Hormone > Flashcards

Anti-Diuretic Hormone Flashcards

1
Q

Anti diuretic means

A

to prevent urination

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2
Q

What is the target organs of antidiuretic hormone?

A

Kidney

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3
Q

Secreted by the posterior pituitary gland

A

Anti-diuretic hormone

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4
Q

Promotes water re-absorption by kidneys

A

Anti-diuretic hormone

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5
Q

“Too low”

A

Diabetes Insipidus

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6
Q

“Too high”

A

SIADH

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7
Q

Described as the passage of very large amounts of dilute urine

A

Diabetes insipidus

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8
Q

2 forms of diabetes insipidus

A

Central (Neurogenic)
Nephrogenic

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9
Q

Causes of Central (Neurogenic)

A

-Idiopathic
- Tumor-associated
- Post-Operative
- Head Trauma
- Hereditary (10%)

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10
Q

Causes of Nephrogenic

A

-Lithium Toxicity
- Hypercalcemia
- Hypokalemia
-Hyperglycemia

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11
Q

Its pathophysiology with ADH synthesis, transport, or release

A

Central (Neurogenic)

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12
Q

Its pathophysiology is inadequate renal response to ADH despite presence of adequate ADH

A

Nephrogenic

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13
Q

Clinical Manifestations of Diabetes Insipidus

A

-Polyuria
- Polydipsia
- Dilute urine
- Hypovolemia

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14
Q

What is the normal specific gravity?

A

1.010-1.025

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15
Q

Diagnostic Test of Diabetes Insipidus

A

Fluid Deprivation Test

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16
Q

Assess ability of kidneys to concentrate urine under the influence of ADH

A

Fluid Deprivation Test

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17
Q

Stages of Fluid Deprivation Test

A

-Fluids are deprived for 8 hours
-Plasma osmolality are checked q4h and urine volume and osmolality q2h
- Desmopressin acetate is given at the end of the 8 hours

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18
Q

Medical Management of Central Diabetes Insipidus

A

Desmopressin (DDAVP)
- A synthetic vasopressin
-Given intranasally (nasal spray) q12 to 24 hours
- Caution: CAD

Chlorpropamide (Diabetes)
-Has an antidiuretic effect in vasopressin- sensitive DI

19
Q

Nursing Management of Central Diabetes Insipidus

A

-During acute episodes
-Hypotonic IV fluids or D5 water, as ordered (to replace urine output)
-Encourage increased oral fluids as tolerated
-Monitor VS, urine output and specific gravity
-Monitor level of consciousness and for signs of dehydration

20
Q

Management of Nephrogenic Diabetes Insipidus

A

-Thiazide diuretics
-Reduces blood flow to the ADH- sensitive distal nephrons
-Indomethacin
-Helps increase renal responsiveness to ADH

21
Q

Collaborative & Nursing Management of Nephrogenic Diabetes Insipidus

A

-Low-sodium diet (no more than 3g/day) (helps decrease urine output)
- Encourage increased oral fluids as tolerated
- Monitor VS, urine output and specific gravity
- Monitor level of consciousness and for signs of dehydration

22
Q

involves the continued secretion or action of arginine vasopressin (AVP) despite normal or increased plasma volume.

A

SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone)

23
Q

Causes of SIADH

A

-Malignancies
-Drugs
-CNS Disorders

24
Q

Drugs that triggers the SIADH

A

-Vinca Alkaloids
-Opioids
-General Anesthetics
-Oxytocin
-Carbamazepine
-Antidepressants

25
Q

CNS Disorders that triggers the SIADH

A

-Head Injury
-Infection (CNS)
- Stroke

26
Q

SIADH tends to be self limiting if causes are:

A

Head trauma or Drugs

27
Q

SIADH may become chronic if associated with:

A

Tumors or metabolic diseases

28
Q

What is the first symptom of hyponatremia?

A

Headache

29
Q

Excessive ADH can increased the reabsorption of water from the collecting ducts back into the circulation. What are the results or the manifestation of it?

A

-Decreased urine volume
- Increased urine specific gravity

30
Q

Excessive ADH can also increased blood volume. What are the factors or the clinical manifestations of it?

A

-Hypertension
-Weight gain

31
Q

3 classification of hyponatremia

A

-Mild hyponatremia
- Moderate hyponatremia
- Severe Hyponatremia

32
Q

Serum sodium level of mild hyponatremia

A

130-134 mmol/L

33
Q

Serum sodium level of moderate hyponatremia

A

125-129 mmol/L

34
Q

Serum sodium level of severe hyponatremia

A

<120

35
Q

Mostly asymptomatic but can report/present with headache, nausea, vomiting, fatigue, confusion, anorexia, muscle cramps

A

Mild Hyponatremia

36
Q

Gait disturbances, headache, vomiting, fatigue, confusion, muscle cramps, depressed deep tendon reflexes

A

Moderate hyponatremia

37
Q

Classification in hyponatremia where delirium, restlessness, agitation, or lethargy, seizures, brainstem herniation, respiratory arrest, coma, death

A

Severe hyponatremia

38
Q

Emergency Management of SIADH with Severe Hyponatremia

A

-3% Hypertonic Saline
-Furosemide (Lasix)- increases excretion of free water thereby limiting treatment-induced volume expansion

39
Q

High yield concept of Emergency Management of SIADH with Severe Hyponatremia

A

-Sodium correction must be made gradually
- Too rapid elevation of sodium levels causes CENTRAL PONTINE MYELINOLYSIS (CPM)

40
Q

Medical Management of SIADH with Mild/Moderate Hyponatremia in Fluid Restriction

A

FLUID RESTRICTION
(First Line of Treatment)

41
Q

Medical Management of SIADH with Mild/Moderate Hyponatremia in VAPTANS

A

-Classified as aquaretics (blocks ADH action and increase water excretion)

CONIVAPTAN
-Given as IV
-Used in combination with fluid restriction
-Should not be used for more than 4 days

TOLVAPTAN
- Given as PO
- Dose needs to be titrated after loading dose up to a max of 60 mg
-Fluid restriction is avoided as it may cause too rapid sodium correction

42
Q

Medical Management of SIADH with Mild/Moderate Hyponatremia in Loop Diuretics

A

-Drug of Choice: Furosemide (Lasix)
-Reduces sodium reabsorption in the Loop of Henle
- Lost sodium is replaced by either 3% saline or PNSS

43
Q

Medical Management of Asymptomatic Chronic SIADH

A

VAPTANS (Alternative)

-Chronic loop diuretic therapy with increased salt intake
(UREA)-Safe to consume
-Increases urine volume
- Dissolve powder in water and take during or after meals
-Antacids may be used if with GI upset

(Mannitol)- Diuretic
-Increases osmolarity of glomerular filtrate thereby preventing reabsorption of water

MS 2 (27 decks)

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