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STEP 2 Endocrine > Edoncr. posterior. SIADH, polydipsia, DI 11-01 (1) > Flashcards

Edoncr. posterior. SIADH, polydipsia, DI 11-01 (1) Flashcards

1
Q

Stimuli for ADH secretion. Osmotic?

A

Serum osmolality > ~ 285

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2
Q

Stimuli for ADH secretion. Nonosmotic?

A

Nausea
Pain
Physical or emotional stress
Hypotension
Hypovolemia
Hypoxia
Hypoglycemia

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3
Q

SIADH. CNS etiologies?

A

eg. stroke, hemorrhage, trauma

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4
Q

SIADH. Medication etiologies?

A

eg carbamazepines, SSRIs, NSAIDs

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5
Q

SIADH. Lung etiologies?

A

eg pneumonia

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6
Q

SIADH. Ectopic secretion?

A

eg small cell lung cancer

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7
Q

SIADH. also etiology - pain and nausea

A

.

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8
Q

SIADH. CP?

A

Volume status and sodium.

Euvolemia - moist mucous membranes, no edema, no JVD

Mild/moderate hypoNa - nausea, forgetfulness

Severe hypoNa - seizures, coma

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9
Q

SIADH. labs?

A

HypoNa
Serum osmolality - hypotonic < 275
Urine osmolality > 100
Urine sodium > 40

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10
Q

SIADH. management?

A

Fluid restriction (< 800 ml/day) +/- salt tablets

For severe - hypertonic saline 3 proc.

Correction gradual (max 10mmol/l within 24 hours, or 0.5 mmol/L/hour) and under ICU observation to
prevent central pontine myelinolysis.

Reverse underlying disease.
Induce diabetes insipidus by giving demeclocycline.

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11
Q

Poliuria. Po situ slepiasi 3 dalykai: primary polydipsia, central and nephrogenic DI.

A

.

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12
Q

Primary polydipsia - cause mechanism?

A

ADH independent (excessive water intake)

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13
Q

Central DI - cause mechanism?

A

ADH deficiency (CNS pathology)

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14
Q

Nephr DI - cause mechanism?

A

ADH resistance (renal disease)

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15
Q

Primary polydipsia - etiology?

A

Antipsyhotics (dry mouth)
Psychiatri conditions

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16
Q

Central DI - etiology?

A

Idiopathic
Trauma
Pituitary surgery
Ischemic encephalopathy

17
Q

Nephr DI - etiology?

A

Chronic lithium use
HyperCALCEMIA
Hereditary mutations in aquaporins (AVPR2 - vasopressor V2 and aqua 2 mutations)

18
Q

Primary polydipsia - water deprivation result?

A

High urine osmolality

19
Q

Central DI - water deprivation result?

A

Low urine osmolality

20
Q

Nephr DI - water deprivation result?

A

Low urine osmolality

21
Q

Primary polydipsia - response to desmopressin?

22
Q

Central DI - response to desmopressin?

A

Increased urine osmolality

23
Q

Nephr DI - response to desmopressin?

24
Q

Evaluation of suspected polyuria scheme. first step?

A

complete 24h urine collection

25
Q

Evaluation of suspected
polyuria scheme. 24h urine collection –> urine output < 3l –>?

A

No true polyuria;
work up causes of urinary frequency

26
Q

Evaluation of suspected
polyuria scheme. 24h urine collection –> urine output > 3l = polyria present –> what evaluate then?

A

dilute or concentrated urine

27
Q

Evaluation of suspected
polyuria scheme. > 3l = polyria present –> concentrated urine - what diuresis and causes?

A

OSMOTIC diuresis

Increased solute excretion (glucose, urea, saline)

28
Q

Evaluation of suspected
polyuria scheme. > 3l = polyria present –> dilute urine - what diuresis and causes?

A

WATER diuresis

Primary polydipsia, DI

29
Q

Water deprivation scheme. first thing prior test?

A

No water 2-3h prior to test

30
Q

Water deprivation scheme.
No water 2-3h prior to test –> 2 things to evalute?

A

Measure urine volume and osmolality every hour

Measure serum osmolality and osmolality every 2 hours

31
Q

Water deprivation scheme.
No water 2-3h prior to test –> evaluate serum (Na) and urine (volume) and osmolality –> Urine osmol > 600 YES –>?

A

Primary polydipsia

32
Q

Water deprivation scheme.
No water 2-3h prior to test –> evaluate serum (Na) and urine (volume) and osmolality –> Urine osmol > 600 NO –>? evaluate and raise 2 questions

A

Urine osmol stable on 2-3 consecutive hourly measurements

Plasma osmol > 295 or plasma sodium Na > 145

33
Q

Water deprivation scheme.

Urine osmol stable on 2-3 consecutive hourly measurements
Plasma osmol > 295 or plasma sodium Na > 145

NO –>?

A

Continue testing until these endpoints are reached

34
Q

Water deprivation scheme.

Urine osmol stable on 2-3 consecutive hourly measurements
Plasma osmol > 295 or plasma sodium Na > 145

YES –>? what to do and monitor

A

Administer desmopresin

Monitor urine osmol and volume every 30 min for 2 hours.

35
Q

Water deprivation scheme.

Administer desmopresin

Monitor urine osmol and volume every 30 min for 2 hours.

When get results, diff. central and neph DI. on what changes?

A

Central DI: incr. urine osmolality 50-100 proc.

Nephr DI: small or no incr. in urine osmolality.

STEP 2 Endocrine (3 decks)

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