Diabetes Insipidus: Symptoms, Diagnosis, and Management PDF

Diabetes Dr. Sibi Peter, PhD, RN,CCRN Insipidus Etiology and Pathophysiology Diabetes Insipidus (DI): Associated with a deficiency of production or secretion of antidiuretic hormone (ADH) or decreased renal response to ADH Either transient or a chronic lifelong condition, dependin...

Diabetes Dr. Sibi Peter, PhD, RN,CCRN Insipidus Etiology and Pathophysiology Diabetes Insipidus (DI): Associated with a deficiency of production or secretion of antidiuretic hormone (ADH) or decreased renal response to ADH Either transient or a chronic lifelong condition, depending on the cause. Types  Central DI (also known as neurogenic)- most common form of DI  Nephrogenic DI- hypokalemia and hypercalcemia may lead to this  Primary DI (also known as psychogenic)- less common Clinical Manifestations  Excretion of large quantities of urine (polyuria)  Polydipsia (excessive thirst)  Clinical Manifestations  Fluid Volume Deficit  Manifested by:  Weight loss  Poor tissue turgor  Hypotension  Tachycardia  Constipation  Shock  (CNS) Manifestations  Ranging from:  Irritability  Mental dullness  Coma  Diagnostic Studies  Identification of the cause is the initial step  Patient History  Physical Examination  Primary or Psychogenic DI is associated with over hydration and hypervolemia rather than dehydration and hypovolemia seen in other forms  Water restriction test is done to confirm the diagnosis of central DI Nursing and Collaborative Management  Early detection  Maintenance of adequate hydration  Patient teaching for long-term management  Therapeutic goal:  Maintenance of fluid and electrolyte balance.   Central DI  Fluid replacement  Hormone replacement  Fluid Volume Status Nursing and Collaborative Assessment Management  Accurate records of:  Intake and output  Urine specific gravity  Daily weights Nursing and Collaborative Management  Desmopressin acetate (DDAVP)- hormone replacement of choice in central DI  Notify health care provider immediately if the patient:  Has ↑ fluid volume w/ low specific gravity Nursing and Collaborative Management  Other drugs available for ADH replacement:  Aqueous vasopressin (Pitressin)  Vasopressin tannate  Lysine vasopressin (Diapid)  Treatment of nephrogenic DI:  Dietary Measures:  Low sodium diet  Thiazide diuretics  When a low-sodium diet and thiazide drug use are not effective, indomethacin (Indocin) may be prescribed.  Student Response Questions  A patient with DI is treated with nasal Desmopressin acetate (DDAVP). The nurse recognizes that the drug is not having an adequate therapeutic effect when the patient experiences  A. headache and weight gain  B. nasal irritation and nausea  C. a urine specific gravity of 1.001  D. an oral intake greater than urinary output Student Response Questions  When caring for a patient with nephrogenic DI, the nurse would expect treatment to include  A. fluid restriction  B. thiazide diuretics  C. a high-sodium diet  D. chlorpropamide (Diabinese) Student Response Questions In a patient with central DI, administration of Aqueous vasopressin (Pitressin) during a water deprivation test will result in A. decrease in body weight B. increase in urinary output C. decrease in blood pressure D. increase in urine osmolality