Anti-Diuretic Hormone

Question 1

Anti diuretic means

Answer 1

to prevent urination

Question 2

What is the target organs of antidiuretic hormone?

Answer 2

Kidney

Question 3

Secreted by the posterior pituitary gland

Answer 3

Anti-diuretic hormone

Question 4

Promotes water re-absorption by kidneys

Answer 4

Anti-diuretic hormone

Question 5

“Too low”

Answer 5

Diabetes Insipidus

Question 6

“Too high”

Answer 6

SIADH

Question 7

Described as the passage of very large amounts of dilute urine

Answer 7

Diabetes insipidus

Question 8

2 forms of diabetes insipidus

Answer 8

Central (Neurogenic)
Nephrogenic

Question 9

Causes of Central (Neurogenic)

Answer 9

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

Question 10

Causes of Nephrogenic

Answer 10

-Lithium Toxicity
- Hypercalcemia
- Hypokalemia
-Hyperglycemia

Question 11

Its pathophysiology with ADH synthesis, transport, or release

Answer 11

Central (Neurogenic)

Question 12

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

Answer 12

Nephrogenic

Question 13

Clinical Manifestations of Diabetes Insipidus

Answer 13

-Polyuria
- Polydipsia
- Dilute urine
- Hypovolemia

Question 14

What is the normal specific gravity?

Answer 14

1.010-1.025

Question 15

Diagnostic Test of Diabetes Insipidus

Answer 15

Fluid Deprivation Test

Question 16

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

Answer 16

Fluid Deprivation Test

Question 17

Stages of Fluid Deprivation Test

Answer 17

-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

Question 18

Medical Management of Central Diabetes Insipidus

Answer 18

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

Question 19

Nursing Management of Central Diabetes Insipidus

Answer 19

-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

Question 20

Management of Nephrogenic Diabetes Insipidus

Answer 20

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

Question 21

Collaborative & Nursing Management of Nephrogenic Diabetes Insipidus

Answer 21

-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

Question 22

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

Answer 22

SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone)

Question 23

Causes of SIADH

Answer 23

-Malignancies
-Drugs
-CNS Disorders

Question 24

Drugs that triggers the SIADH

Answer 24

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

Question 25

CNS Disorders that triggers the SIADH

Answer 25

-Head Injury -Infection (CNS) - Stroke

Question 26

SIADH tends to be self limiting if causes are:

Answer 26

Head trauma or Drugs

Question 27

SIADH may become chronic if associated with:

Answer 27

Tumors or metabolic diseases

Question 28

What is the first symptom of hyponatremia?

Answer 28

Headache

Question 29

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?

Answer 29

-Decreased urine volume - Increased urine specific gravity

Question 30

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

Answer 30

-Hypertension -Weight gain

Question 31

3 classification of hyponatremia

Answer 31

-Mild hyponatremia - Moderate hyponatremia - Severe Hyponatremia

Question 32

Serum sodium level of mild hyponatremia

Answer 32

130-134 mmol/L

Question 33

Serum sodium level of moderate hyponatremia

Answer 33

125-129 mmol/L

Question 34

Serum sodium level of severe hyponatremia

Answer 34

<120

Question 35

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

Answer 35

Mild Hyponatremia

Question 36

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

Answer 36

Moderate hyponatremia

Question 37

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

Answer 37

Severe hyponatremia

Question 38

Emergency Management of SIADH with Severe Hyponatremia

Answer 38

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

Question 39

High yield concept of Emergency Management of SIADH with Severe Hyponatremia

Answer 39

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

Question 40

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

Answer 40

FLUID RESTRICTION (First Line of Treatment)

Question 41

Medical Management of SIADH with Mild/Moderate Hyponatremia in VAPTANS

Answer 41

-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

Question 42

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

Answer 42

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

Question 43

Medical Management of Asymptomatic Chronic SIADH

Answer 43

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