SIADH and DI

Question 1

what does SIADH stand for

Answer 1

syndrome of inappropriate antidiuretic hormone

Question 2

what is SIADH

Answer 2

abnormal production of sustained secretion of ADH
Think “soaked inside”
“Low Liquidity Labs”

Question 3

how is SIADH characterized

Answer 3

fluid retention
serum hypoosmolality
hyponatremia
concentrated urine

Question 4

what does ADH signal the kidneys to do?

Answer 4

hold fluid

Question 5

When is SIADH self limiting?

Answer 5

drug related or head injury

Question 6

when is SIADH chronic?

Answer 6

cancer

Question 7

what causes SIADH?

Answer 7

malignant tumors “small cell lung cancer”
head trauma, stroke, brain tumors
morphine, SSRI’s, some chemos
Hypothyroidism, infection

Question 8

SIADH pathophysiology map (4 steps)

Answer 8

1. increased ADH
2. increased water absorption in renal tubules
3. increased intravascular fluid volume
4. dilutional hyponatremia and decreased serum osmolality

Question 9

what is the song that goes along with SIADH?

Answer 9

lung tumors, trauma, and bad bugs a complication might be, SIADH, SIADH, SIADH, this hormone stops the PEE PEE
low output, sodium; gained weight and high specific gravity, SIADH, SIADH, SIADH, this hormone stops the PEE PEE

Question 10

What osmolality is low with SIADH?

Answer 10

serum, sodium,urine

Question 11

what osmolality is high with SIADH?

Answer 11

urine specific gravity

Question 12

do you gain or loose weight with SIADH?

Answer 12

gain

Question 13

in SIADH your patient is retaining ____ ____, without ____

Answer 13

pure water; salt

Question 14

manifestations of SIADH depend on

Answer 14

severity and onset of hyponatremia

Question 15

clinical manifestations of SIADH

Answer 15

hyponatremia causing dyspnea and fatigue
neurological- dulled sensations, confusion, lethargy, muscle twitching, convulsions
GI- impaired taste, no appetite, vomiting, abd cramps

Question 16

what serum sodium level indicates hypovolemic shock and what does this cause?

Answer 16

Na+ less than 100-115

irreversible neurologic damage

Question 17

can you die of water intoxication?

Answer 17

YES

Question 18

what is water toxicity and how does this happen and what cells are primarily effected?

Answer 18

excessive intake of water, serum sodium is super low causing cells to swell, especially in the brain causing increased intracranial pressure. can be deadly

Question 19

is pharmacotherapy the first line of tx for SIADH?

Answer 19

Nope, tx is directed at the underlying cause

ex: discontinuing offending med

Question 20

what do you treat chronic SIADH with?

Answer 20

demeclocycline
used in cancer patients
can counteract SIADH

Question 21

What is Diabetes Insipidus? (DI)

Answer 21

deficiency of ADH
decreased renal response to ADH
think “ DRY INSIDE”

Question 22

what is DI characterized by?

Answer 22

excessive loss of water in urine
increased thick blood
increased urine output

Question 23

what are the two forms of DI?

Answer 23

neurogenic (central)

Nephrogenic

Question 24

what is neurogenic (central DI?)

Answer 24

tumor in the brain
hypothalamus or pituitary gland damage
SUDDEN onset
usually PERMANET

Question 25

what is nephrogenic DI?

Answer 25

``` kidneys not responding to ADH loss of kidney function often drug related (lithium) onset- SLOW course of disease-PROGRESSIVE ( as kidney function worsens symptoms increase) ```

Question 26

what disorders are associated neurogenic DI

Answer 26

stroke traumatic brain injury brain surgery cerebral infections

Question 27

what disorders are associated with nephrogenic DI

Answer 27

CKD

Question 28

pathophysiology map of DI- 5 parts

Answer 28

1. decreased ADH 2. Decreased water reabsorption in renal tubules 3. decreased intravascular fluid volume 4. HYPERNATREMIA 5. excessive urine output

Question 29

what osmolality is low with DI?

Answer 29

urine

Question 30

do you gain or loose weight with DI?

Answer 30

loose

Question 31

What osmolality is high with DI?

Answer 31

serum, sodium

Question 32

is urine output high or low with DI?

Answer 32

high

Question 33

clinical manifestations of DI

Answer 33

``` polyuria polydipsia dehydration electrolyte imbalances hypovolemic shock/death "drinking themselves to death, peeing themselves to death" ```

Question 34

what is pharmacology tx for neurogenic DI?

Answer 34

synthetic ADH replacement | desmopressin

Question 35

what do you use to treat nephrogenic DI?

Answer 35

thiazide diuretics

Question 36

why are diuretics used in someone who is peeing constantly?

Answer 36

paradoxical effect | decreased polyurina, increases osmolality

Question 37

what is the song for DI?

Answer 37

Diabetes insipidus the opposite you'll see PEE PEE, GIVE IV's.; PEE PEE GIVE IV's, PEE PEE GIVE IV's; desmopressin they need!

Question 38

What does D-I-L-U-T-E stand for in DI

Answer 38

``` DRY I and O daily weight Low specific gravity Urinate lots Treat= vasopressin rEhydrate ```

Question 39

hyperthyroidism

Answer 39

excessive secretion of T3 and T4 | has 3 times primary, secondary, tertiary

Question 40

primary hyperthyroidism

Answer 40

thyroid gland over producing T3 and T4 | GRAVES disease

Question 41

secondary hyperthyroidism

Answer 41

pituitary uncommon pituitary gland over produces

Question 42

tertiary hyperthyroidism

Answer 42

hypothalamus | excessive secretion from hypothalamus

Question 43

graves disease

Answer 43

most common hyperthyroidism AUTOIMMUNE stimulation of thyroid gland excessive T3 and T4 thyroid stimulating antibodies causing gland to enlarge

Question 44

other causes of hyperthyroidism

Answer 44

thyroid adenoma, subacute thyroiditis, toxic multinodular goiter, excessive iodine ingestion, excessive hormone production

Question 45

risk factors for hyperthyroidism

Answer 45

``` fx of graves greater than 40 women Caucasian AMIODERONE excessive iodine intake pregnancy ```

Question 46

symptoms of Graves Disease

Answer 46

``` nervousness insomnia sensitivity to heat weight loss audible bruit over thyroid afib myxedema exophthalmos ```

Question 47

exophthalmos

Answer 47

``` thyroid eye disease bulging eyes wide-eye stare periorbital edema Graves ophthalmopathy women often effected ```

Question 48

graves is diagnosed by

Answer 48

``` LOW tsh HIGH T3 and T4 antithyroglobulin antithyrotropin receptor antibody US with color doppler radioactive iodine scan with measurements of iodine uptake ```