Fluid and Electrolytes: SIADH-Diabetes Insipidus Flashcards
What is Diabetes insipidus?
A disease that causes ADH insufficiency that leads to excess fluid excretion
What are the possible causes of Diabetes Insipidus?
- Injury to the hypothalamus
- Injury to the Pituitary Gland
- Certain medication adverse reactions
- Can be born with a deficiency
- Tumors or any obstruction
- Infection
- Stroke/Cerebral vascular diseases
- Renal Insufficiency
What are the manifestations of Diabetes Insipidus?
- hypotension
- tachycardia
- Weak peripheral pulses
- Hemoconcentration
- Increased urine output
- Dilute specific gravity
- Poor turgor
- Dry mucous membranes
- Decreased Cognition
- Ataxia (loss of control of body movements)
- Increased thirst
- Irritability
What serum labs are consistent with Diabetes Insipidus?
- low ADH level due to excessive water secretion
- Elevated Sodium levels due to concentration in blood
- Elevated Osmolality level due to concentration in blood
- Elevated BUN due to concentration in blood
- Elevated Hct due to concentration in blood
What urine labs are consistent with Diabetes Insipidus?
- Low sodium level
- Low osmolality level
- Low Specific Gravity level
What interventions should a nurse keep in mind for a person with Diabetes Insipidus because of fluid volume deficit?
- Monitor neuro status due to possible changes in mental status secondary to electrolyte imbalances
- Avoid foods/drinks that may have a diuretic effect such as caffeine
- add bulk, fiber, and juices to prevent constipation
- Monitor for VS and trends
- Monitor lab values and trends (sodium level, BUN, Hct, Serum Osmolality, low ADH, Specific Gravity
What neuro interventions should be included in care for Diabetes Insipidus?
- Maintain Seizure precautions due to hypernatremia which increases the risk for seizure
- besides electrolyte imbalances, a deficiency in ADH may be a cause of a head injury to the hypothalamus/pituitary causing neurologic changes
- Decreased Central Venous Pressure (CVP) increases the risk for altered mental status
What is the normal range for CVP (central venous pressure)?
1-8 mmHg
What is important to remember about sodium levels for patients with Diabetes insipidus?
In cases where a patient is placed on a sodium-restricted diet due to excessive sodium intake; the Diabetes insipidus patient is NOT placed on a sodium-restricted diet because their sodium level is due to the serum concentration, not intake
What are interventions for Hypovolemia with Diabetes Insipidus?
- monitor for sx
- Administer Vasopressin aimed at retaining water and constricting blood vessels
- Administer fluids to replace loss
- Daily weights to monitor fluid balance and monitor trends
- Intake and output to monitor balance
- Skin care due to possible skin dryness/cracking secondary to dehydration
- Oral care due to dry mucous membranes and excessive thirst (polydipsia)
What is classified as anuria?
0-100 ml/day (no urine)
What is classified as oliguria?
<500 mL/day (only a little urine)
What is the normal adult range for urine output per day?
1-2 L/day (at least 30ml/hr)
What is classified as polyuria?
> 2L/day
How much urine does someone with diabetes insipidus release each day?
5-20 L/day