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endocrine > DI > Flashcards

DI Flashcards

1
Q

Diabetes Insipidus

A

Antidiuretic hormone (ADH or vasopressin) deficiency or resistance.

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2
Q

Pituitary/Hypothalamus causes for DI

(central type)

A

Autoimmune response to ADH secreting cells

Damage to the hypothalamus or pituitary stalk

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3
Q

Nephrogenic causes of DI

A

Defect in kidney tubules; kidneys fail to respond to circulating ADH

hypokalemia or hypercalcemia or hyperpararthyroidism

Certain drugs may cause this lithium, corticosteroids, DDAVP

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4
Q

Very rare Polydipsia two to twenty liters of fluid per day

familial?

A

DI

Polyuria Familial autosomal dominant DI symptoms begin at age 2

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5
Q

DI symptoms

A

Very rare, Polydipsia two to twenty liters of fluid per day, dilute urine, THIRSTY, DEHYDRATION

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6
Q

24 hour urine for volume and creatinine Sodium, potassium Serum osmolality HIGH

Urine osmolality LOW

Vasopressin LOW IN CENTRAL AND HIGH IN NEPHROGENIC

A

DI labs

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7
Q

DI labs

A

24 hour urine for volume and creatinine Sodium, potassium Serum osmolality HIGH

Urine osmolality LOW

Vasopressin LOW IN CENTRAL AND HIGH IN NEPHROGENIC

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8
Q

Vasopressin challenge

A

Urine volume for 12 hours

Desmopressin acetate is given

LOW FOR CENTRAL AND HIGH FOR NEPROGENIC

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9
Q

SIADH

A

The syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH) is characterized by excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary gland or another source. The result is HYPOTONIC hyponatremia and sometimes fluid overload.

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10
Q

if you suspect SIADH…

A

CT to rule out CNS d/o and CXR to rule out lung pathology

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11
Q

demeclocycline for what?

risks?

A
  • for chr hyponatremia unresponsive to fluid restriction; to induce nephrogenic DI. Inhibits ADH!
  • may cause neprotoxicity in pts with cirrhosis
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12
Q

ADH from what

A

pituitary hormone

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13
Q

SIADH found in what diseases

A

It is usually found in patients diagnosed with small-cell carcinoma of the lung, pneumonia, brain tumors, head trauma, strokes, meningitis, and subarachnoid hemmorhage.

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14
Q

SIADH

urine osmolality

urine sodium

A

osmolality greater than 100

sodium greater than 40

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15
Q

hyponatremia clinical symptoms

A

lethargy, disorientation, muscle cramps, anorexia, hiccups, N/V, confusion

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16
Q

signs of hyponatremia

A

HYPOreflexia, orthostatic hypoTN, cheyne stokes respirations, coma, stupor, delirium, agitation

17
Q

lethargy, disorientation, muscle cramps, anorexia, hiccups, N/V, seizures

A

hyponatremia clinical symptoms

18
Q

HYPOreflexia, orthostatic hypoTN, cheyne stokes respirations, coma, stupor, delirium, agitation

A

signs of hyponatremia

19
Q

what can progress to seizures, coma, or brainstem herniation

A

hyponatremia

20
Q

formula for serum osmolality

A

(2 x serum Na) + (BUN/2.8) + (glucose/18)

21
Q

dangers of correcting hyponatremia too rapidly

A

central pontine myelinolysis or osmotic demyeination

22
Q

? order what tests if SIADH suspected

A

CT and CXR

23
Q

hyponatremia treatment in

1) hypervolemic & euvolemic
2) hypovolemic

A

1) water restriction +/- diuretics
2) Normal saline

24
Q

chronic hyponatremia tx

1) rate
2) unresponsive to fluid restriction
3) euvolemic or hypervolemic hyponatremia

A

1) over 72 hr duration with <8 mEq/L/day
2) demeclocycline
3) vasopressin antagonists(conivaptan)

25
Q

causes of DI

1) neurogenic
2) nephrogenic
3) acquired

A

Neurogenic: deficient secretion of ADH from pituitary

nephrogenic: kidneys unresponsive to normal vasopressin levels, inherited X linked trait,

acquired from lithium therapy, HYPOkalemia, HYPERcalcemia, or renal disease

26
Q

main symptoms of DI

A

polyuria(50-60 mL/kg/day), nocturia, polydipsia, hypotension

maybe seizures

27
Q

how to differentiate neurogenic and nephrogenic DI

A

Water deprivation and desmopresin testing(DDAVP):

NEUROGENIC(central) DI: dec urine output and increased urine osmolality

if little or no change in urine osmolality, it is most likely NEPHROGENIC DI

28
Q

urine osmolality less than 250 mOsm/kg

A

despite hyperkalemia

it is NEPHROgenic DI

29
Q

tx for central DI and nephrogenic DI

A

central: DDAVP
nephrogenic: salt restriction and water intake, thiazide diuretics

30
Q

labs in volume depletion

A

hemocrit and serum albumin increased

urinary sodium decreases

urea increases (secondary to urine stasis in nephron) but little change in serum Cr

endocrine (9 decks)

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