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Complex Care > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is SIADH?

A

Syndrome of inappropriate antidiuretic hormone

Excess ADH –> physiologic imbalance of water

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2
Q

What is the pathology of SIADH?

A
  1. Increased ADH
  2. Increased water reabsorption in tubules
  3. Dilution hyponatremia and decreased serum osmolarity
  4. Increased intravascular volume
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3
Q

What are the causes of SIADH

A
  1. CNS disturbances (stroke, hemorrhage, infection, trauma, psychosis)
  2. Malignancies
  3. Drugs (carbamazepine, SSRI, and cyclophosphamide)
  4. Surgery (transsphenoidal pituitary and head injury)
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4
Q

What are the clinical manifestations of SIADH? (13)

A
  1. Serum sodium below 125
  2. Thirst, exertional dyspnea, fatigue, HA, muscle cramps
  3. GI: vomiting, abd cramps
  4. Muscle twitching
  5. Cerebral edema, confusion, seizures, coma
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5
Q

What does the physical exam of a patient with SIADH look like?

A
  1. No edema
  2. Dry mucous membranes
  3. Decreased skin turgor
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6
Q

What is the diagnostic criteria SIADH?

A
  1. Decreases serum osmolarity
  2. Urine osmolarity >100
  3. Euvolemic clinical examination
  4. With normal sodium intake, urine sodium >40
  5. Normal thyroid, adrenal, renal and cardiac functioning
  6. No recent used of diuretics
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7
Q

How do you treat SIADH?

A
  1. Treat underlying disease
  2. Fluid restriction of less than 800ml/day
  3. Correct sodium deficit with 3% NaCl, or NaCl 2-3 gram tablets
  4. Loop diuretic or vasopressin receptor antagonist (blocks ADH to increase peeing)
  5. Demeclocycline
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8
Q

What does demeclocycline do for SIADH?

A

Acts on the collecting tubule cell to diminish its responsiveness to ADH –> increasing water excretion and increasing the release of intravascular volume

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9
Q

What are some nursing considerations for SIADH?

A
  1. Strict I/O
  2. Daily weights
  3. Fall precautions
  4. Lower the HOB flat or less than 10 degrees to decrease pressure on the heart so the it will decrease the production of ADH
  5. Seizure precautions
  6. Listen to heart and lungs
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10
Q

What is DI?

A

Diabetes insipidus

Deficiency if ADH –> physiologic imbalance of water by ether neurogenic or nephrogenic

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11
Q

What is neurogenic?

A

insufficient production of ADH

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12
Q

What is nephrogenic?

A

unresponsiveness of the renal tubules to ADH

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13
Q

What is the pathology of DI?

A
  1. Decreased ADH
  2. Decreased water reabsorption in the renal tubules
  3. Excessive urine output and increased serum osmolarity
  4. Decrease intravascular volume
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14
Q

What are the diagnostics for DI?

A
  1. Water deprivation test where the apteint drinks fluids overnight and then is deprived for fluids for 8 hours in the morning. Monitor plasma osmolarity hourly and urine osmolarity every 2 hours. After 8 hours the pt. is given desmopressin (DDVAP)

Confirmed DI if serum osmolarity is >305

Goal: show that polyuria is d/t inability to concentrate urine

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15
Q

What are the causes of neurogenic DI? What is the urine osmolarity in response to the water deprivation test?

A
  1. Brain tumor
  2. Head injury
  3. Brain surgery
  4. CNS infection

Urine osmolarity >800

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16
Q

What are the causes of nephrogenic DI? What is the urine osmolarity in response to the water deprivation test?

A
  1. Drug therapy
  2. Renal damage
  3. Hereditary renal disease

Urine osmolarity <300

17
Q

How do you manage neurogenic DI?

A

Desmopressin (DDVAP) intranasally

18
Q

How do you manage nephrogenic DI?

A
  1. Removal of the underlying cause such as lithium therapy
  2. Amiloride 5mg/day for lithium related disease
  3. Low sodium diet and chlorothiazide to induce mild sodium depletion
19
Q

What are the nursing considerations for DI?

A
  1. Strict I/O
  2. Daily weights
  3. Hypotonic IV solution
20
Q

DI overview

A
  1. High urine output
  2. Low levels of ADH
  3. Hypernatremia
  4. Dehydrated
  5. Lose too much fluid
  6. Excessive thirst
21
Q

SIADH overview

A
  1. Low urine output
  2. High levels of ADH
  3. Hyponatremia
  4. Over hydrated
  5. Retain too much fluids
  6. Excessive thirst
22
Q

What type of cancer is most likely to cause SIADH?

A

Small cell lung cancer

Complex Care (22 decks)

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