Diabetes Insipidus and SIADH

Question 1

excess ADH, leading to water retention, and dilutional hyponatremia and decreased osmolality

Answer 1

SIADH

Question 2

what is a common late complication of transsphenoidal pituitary surgery?

Answer 2

SIADH

Question 3

a patient presents with decreased urine output, n/v, lethargy/weakness, changes in neurological status, muscle cramps, weight gain w/out edema, and hypertension. what are they likely experiencing?

Answer 3

SIADH

Question 4

what are symptoms of n/v, lethargy/weakness, and changes in neurological status due to, in SIADH?

Answer 4

cerebral edema - cells in extracellular space swelling with fluid

Question 5

a patient presents with increased plasma ADH, hyponatremia, serum hypoosmolality, increased urine osmolality, and increased urine specific gravity. what are they likely experiencing?

Answer 5

SIADH

Question 6

what is the treatment goal for SIADH?

Answer 6

treat underlying cause

Question 7

what is the main acute treatment for SIADH?

Answer 7

fluid restriction

Question 8

in a patient with SIADH, how can we treat hyponatremia?

Answer 8

hypertonic IV solution or salt tablets

Question 9

in a patient with SIADH, how can we treat the increased urine osmolality?

Answer 9

loop diuretics

Question 10

in a patient with SIADH, how can we treat the hypertension? (2)

Answer 10

vasopressin receptor antagonist:
conivaptan
tolvaptan

Question 11

decreased release of ADH that leads to hypovolemia and dehydration

Answer 11

central diabetes insipidus

Question 12

what is the most common cause of central diabetes insipidus?

Answer 12

idiopathic

Question 13

a patient presents with polyuria, polydipsia, nocturia, dry skin and mucous membranes, and +/- hypotension. what are they likely experiencing?

Answer 13

diabetes insipidus

Question 14

a patient presents with hypernatremia, serum hyperosmolality, urine output >3L/day, decreased urine specific gravity and urine osmolality, and decreased plasma ADH. what are they likely experiencing?

Answer 14

central diabetes insipidus

Question 15

what can be ordered in a patient with suspected diabetes insipidus?

Answer 15

24-hr urine collection

Question 16

what is the last diagnostic that can be used to determine if a patient has diabetes insipidus? what will be seen?

Answer 16

vasopressin challenge test with desmopressin acetate
a change in urine output will be seen

Question 17

what is the treatment goal for diabetes insipidus?

Answer 17

control nocturia, polyuria during the day and avoid hyponatremia

Question 18

what is the preferred medication to treat diabetes insipidus?

Answer 18

desmopressin (nasal spray preferred)