Diabetes Insipidus Flashcards

1
Q

Diabetes insipidus

A

Condition of insufficient ADH that results in the inability of the body to concentrate or retain water
Produces large volumes of dilute urine

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2
Q

How much urine can be excreted daily?

A

Varies from 4 L to 20 L/day

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3
Q

Characteristics of urine

A

Dilute
Low specific gravity
Low osmolarity
Increased plasma osmolarity

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4
Q

Central Diabetes Insipidus

A

Caused by a defect in the hypothalamus or pituitary gland, resulting in a lack of ADH production or release
Also occurs with increased cranial pressure
Kidneys go into overdrive

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5
Q

Nephrogenic Diabetes Insipidus

A

Caused by inadequate kidney response to the presence of ADH

Rare

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6
Q

Psychogenic Diabetes Insipidus

A

Water intoxication due to psychiatric disturbance

The uncontrollable urge to drink

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7
Q

Pathophysiology of diabetes insipidus

A

Hyposecretion of ADH and a deficiency of vasopressin
Results in failure of tubular reabsoprtion of water in kidneys leading to polyuria and dehydration
Dehydration increases plasma osmolarity
Stimulates osmoreceptors
Relays sensation of thirst

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8
Q

What can happen if thirst mechanism is poor or absent?

A

Severe dehydration and death can occur

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9
Q

Cardiovascular clinical manifestations

A
Hypotension (postural)
Decreased pulse pressure
Tachycardia
Weak peripheral pulses
Hemoconcentration 
-Increased hbg and hct
-Increased BUN
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10
Q

Renal clinical manifestations

A

Increased urine output with dilute, low specific gravity, hyposomolar

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11
Q

Integumentary clinical manifestations

A

Dehydration
Poor turgor
Dry mucous membranes

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12
Q

Neurologic clinical manifestations

A
Increased sensation of thirst
Irritability, headache
Decreased cognition
Hyperthermia
Lethargy to coma
Ataxia
Hypernatremia
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13
Q

What are most clinical manifestations related to?

A

Dehydration

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14
Q

How do you diagnose diabetes insipidus?

A

Health and physical
CT/MRI of brain
Fluid deprivation test

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15
Q

Fluid deprivation test

A

Baseline body weight, urine volume, urine osmolality, and specific gravity
NPO for 8-12 rhs
Administer desmopressin (DDAVP) intranassaly or subcutaneously
30-60 minutes after administration, obtain urine and serum osmolality and compare to baseline
CENTRAL DI: urine Osm > 300 decreased output
NEPHROGENIC DI: not much change

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16
Q

Low specific gravity for dilute urine

A

Less than 1.005

17
Q

Low osmolarity

A

Less than 100mOsm/kg

18
Q

Management of central diabetes insipidus

A
Do not restrict oral intake
IVF: hypotonic solutions
Drug therapy includes:
-Desmopressin acetate (DDAVP) - with URTI, oral, or SQ vasopressin used
-Vasopressin tannate
-Oral: chlorpropamide, carbamazepine
19
Q

Chlorpropamide

A

Sulfonylureas
Helped to control high blood sugar, treat type 2 diabetes with diet and exercise
May make you more sensitive to the sun
Do not use if you have type 1 diabetes, DKA, severe liver, kidney, thyroid, endocrine problems
Take in morning with breakfast
If you miss dose, take as soon as you remember, do not miss any doses

20
Q

Desmopressin (central DI)

A

Antidiuretic hormone
Causes the kidneys to produce less urine
Do not use if you have moderate kidney problems or a history of low blood sodium levels

21
Q

Vasopressin (central DI)

A

Helps prevent loss of water from body by reducing urine output and helping kidneys reabsorb water into body
Follow orders for fluid intake

22
Q

Hydrochlorothiazide (nephrogenic DI)

A

Thiazide diruetic

Helps prevent body from absorbing too much salt

23
Q

Indomethacin

A

NSAID

May increase risk of fatal HA or stroke if used long term or high doses

24
Q

Nephrogenic diabetes insipidus management

A

Dietary management (low sodium diet, less than 3 grams per day, low protein)
Thiazide diuretics
NSAID
-PPIs are given to prevent gastric ulcers

25
Q

Nursing Diagnosis

A

Impaired urinary elimination r/t polyuria
Confusion r/t dehydration and hyperosmolality
Fluid volume deficit r/t polyuria
Knowledge deficit r/t diagnosis, tests, and treatment
Risk for altered body temp r/t dehydration

26
Q

Assessment

A

Recent hypophysectomy, head trauma, brain tumor, infection, or use of drugs that inhibit ADH release
Obtain a list of current and past medications
Does individual complain of urinary frequency or excessive thirst?
Signs of dehydration (fluid and electrolytes)
Bladder distention

27
Q

Interventions

A

Monitor VS and neuro/cardio status
Provide safe environment, particularly in the cliant with change in LOC or mental status
Monitor electrolyte values and for signs of dehydration
Monitor I/O, daily weights, specific gravity of urine
Maintain intake of adequate fluids
Instruct client to avoid foods/liquids with diuretic type action
Administer DDAVP or thiazide diuretics with NSAIDs as indicated
Monitor for over treatment with DDAVP (weight gain w/ fluid overload or water retention, headache, hyponatremia, change in LOC)
Limit sodium to less than 3 g and do not restrict water intatke

28
Q

Evaluation and outcome

A

Has client noted a decrease in urinary frequency and excessive thirst?
Are I/O, specific gravity, lab values normalized?
Is client able to verbalize understanding of disease process, test, and care needs?
Is client compliant with therapy?