Disorders Of Water Balance

Question 1

signs and symptomsof SIADH

Answer 1

Usually clinical features of water intoxication:
– Nausea
– Vomiting
– Muscle weakness
– Neurological irritability
– Convulsions and coma
– Oedema
– Dilutional hyponatraemia without dehydration

Question 2

Management of SIADH

Answer 2

Avoid excessive oral or intravenous fluid intake
Fluid restriction
Sodium replacement

Question 3

Classify diabetes insipidus according to the pathogenesis

Answer 3

Central diabetes insipidus
–due to lack of secretion of ADH by the posterior pituitary
– Maybe partial or complete
– maybe inherited but most commonly acquired
– – cerebral malformations, lesions in the hypothalamic-pituitary areaE.g. craniopharyngioma, following neurosurgery

Nephrogenic diabetes insipidus
– Insensitivity to ADH at the renal tubular level
– Usually X-linked dominant
– Usually present soon after birth

Question 4

Major signs and symptoms of diabetes insipidus

Answer 4

Polyuria: dilute glucose free, pale coloured
Polydipsia
Failure to thrive
Thirst
Chronic dehydration
Biochemical: low urine osmolality, high serum osmolality

Question 5

Pathogenesis of type one diabetes

Answer 5

Pancreatic beta-cell destruction usually T-cell mediated

Question 6

Signs and symptoms of type one diabetes

Answer 6

Polyuria
Polydipsia
Blurring of vision
Weight loss
Associated glycosuria and ketouria

Question 7

Confirm a Tory testing for diabetes type one

Answer 7

Fasting glucose greater than seven
Random glucose greater than 11.1
Test for antibodies to islet cells and GAD

Question 8

Clinical features of DKA

Answer 8

Acidotic breathing
Nausea
Vomiting
Abdominal pain
Depressed level of consciousness
Coma

Question 9

Management of DKA

Answer 9

-Intravenously fluids with an initial bolus replaced evenly over 36 to 48 hours
-insulin at 01 units per kilogram per hour
– Dextrous when glucose drops to below 11
– potassium replacement if renal function is adequate
–

Question 10

Complications of DKA

Answer 10

Cerebral Oedema

Question 11

Signs and symptoms of congenital hhypothyroidism

Answer 11

At birth:
An open posterior fontanelle
Umbilical hernia
Course facial features
Poor Sucking

At 2-3 months
Prolonged unconjugated hyperbilirubinaemia
Macroglossia
Hypertonia
Dry skin
Constipation
Hypothermia

Question 12

What is the pathogenesis of neonatal hyperthyroidism

Answer 12

Transplacental passage of thyroid-stimulating immunoglobulins from a mother with graves disease

Question 13

Which conditions is SIADH associated with

Answer 13

Severe meningitis e.g.tuberculosis
Head injury
Pulmonary disorders
Vincristine therapy