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2a Endocrinology > Water balance, diabetes Insipidus and hyponatraemia > Flashcards

Water balance, diabetes Insipidus and hyponatraemia Flashcards

1
Q

What is Diabetes Insipidus now called?

A

Arginine vasopressin deficiency - AVP Deficiency

Arginine vasopressin resistance - AVP Resistance

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2
Q

What hormones are stored in the posterior pituitary?

A

Vasopressin and oxytocin

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3
Q

Where are vasopressin and oxytocin made?

A

Paraventricular nucleus and Supraoptic nucleus

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4
Q

True or false: Vasopressin has a long half life

A

False, it’s short, 5-10 mins

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5
Q

ADH bind to _-_____ coupled 7 transmembrane domain receptors

A

G-protein

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6
Q

Release of vasopressin is controlled by what in day to day?

A

Osmoreceptors in hypothalamus

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7
Q

Release of vasopressin is controlled by what in emergencies?

A

Baroreceptors in brainstem and great vessels

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8
Q

ingestion of water leads to ____ in plasma osmolality

A

drop

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9
Q

drop in plasma osmolality results in _____ cellular hydration

A

increased

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10
Q

Decreased vasopressin secretion causes _____ urine water excretion by kidney

A

increased

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11
Q

The vasopressin loop is sensitive to small changes in p____ o____

A

plasma osmolality

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12
Q

vasopressin binds to __ receptors on the renal collecting duct principle cells

A

V2

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13
Q

Osmolality

A

Concentration in plasma per kilo

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14
Q

Symptoms of AVP deficiency and resistance

A

Polyuria
Polydypsia
No glycosuria

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15
Q

Diagnosis of AVP deficiency and resistance

A

Measure urine volume - unlikely if urine volume <3l/day
Check renal function and serum calcium, biochemistry

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16
Q

Management of AVP deficiency

A

Treat any underlying condition

Desmopressin - high activity at V2 receptor. Can be tablets, nasal spray or injection.

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17
Q

What can you measure to help diagnose Diabetes insipidus

A

Copeptin

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18
Q

Management of AVP resistance

A

Avoid precipitating drugs
Congenital, free access to water, very high dose desmopressin

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19
Q

Hyponatraemia is most often caused by excess water rather than…

A

salt loss

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20
Q

Definition of hyponatraemia

A

serum sodium < 135 mmol/l

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21
Q

What is normal serum sodium levels

A

135-144 mmol

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22
Q

Symptoms of hyponatraemia

A

Headache
Irritability
Nausea/vomiting
Mental slowing
Unstable gait / falls
Confusion / Delirium
disorientation
Stupor / coma
Convulsions
Respiratory arrest

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23
Q

What is biochemical classification of mild hyponatraemia?

A

130-135 mmol/l

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24
Q

What is biochemical classification of moderate hyponatraemia?

A

125-129 mmol/l

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25
Q

What is biochemical classification of severe hyponatraemia?

A

<125 mmol/l

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26
Q

True or false: start hypotonic fluids in hyponatraemic patients

A

False - stop these

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27
Q

What tests to do for hyponatraemia

A

Plasma and urine osmolality
urinary Na+
Glucose
TFT’s
Assessment of Cortisol
Assessment of underlying causes eg chest imaging

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28
Q

SIADH

A

Syndrome of Inappropriate Antidiuretic hormone

Common cause of hyponatraemia

Too much AVP, low osmolality, plasma sodium is low, urine is inappropriately concentrated, water retention, increase GFR

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29
Q

SIAD management

A

Fluid restriction
Diagnose and treat underlying condition
Sometimes demeclocycline / vaptan

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30
Q

The brain undergoes _____ adaptation in response to gradual-onset hyponatraemia

A

volume

30
Q

Management of acute sever symptomatic hyponatraemia

A

IV 150ml of 3% saline over 20 mins

Check serum Na+

Repeat twice until 5 mmol/l increase Na+

Stop hypertonic saline. Na+ 6 hourly for 1st 24 hours

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2a Endocrinology (13 decks)

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