Understanding Diabetes Insipidus and SIADH: Causes, Symptoms, and Treatments

there are two short topics diabetes insipidus and siadh both of these are complications

they do not exist by themselves meaning once the patient gets this diagnosis your next question will be

what caused it okay because the treatment will be of course we treat the underlying cause what what led to the

disorder so these are two opposites we have diabetes and CPUs and siadh which is syndrome of inappropriate

anti-diuretic hormone now even though the the the name here suggest diabetes this has nothing to do with blood sugar

it is an endocrine disorder just like diabetes metis however this one is a anti-diuretic hormone deficiency problem

there are three forms of diabetes andus it can be primary can be secondary it can also be nephrogenic

in e in any case whether it's primary secondary or nephrogenic the patient has decreased not enough anti dtic hormone

okay so again let's review anti dtic hormone is produced by the hypothal by the sorry hypothalamus however it's

controlled by ep pituitary gland okay its action is simply on water it has no direct effect on sodium however

indirectly because as a result here you don't have enough anti-erotic hormone so during

emergency episodes wherein you need it you don't have it as a result the patient excretes large volumes of dilute

urine okay so let's look at the causes again so usual cause is head trauma now don't be restrictive when we say head

trauma it's not just somebody falling from the l or getting into a card accident trauma also involves brain

surgery correct or hemorrhagic stroke or stroke itself all of those indicate the patient had some sort of trauma meaning

some sort of injury or lack of blood flow to one or more parts of the brain all right so all of those constitute

head trauma which can cause diabetes and citus some rare cases can be idiopathic

meaning we have no idea what's causing the patient's diabetes and zpus but that's quite rare most of the time we

can pinpoint the the exact cost okay so most cases we can see oh patient had a stroke or patient has some brain tumor

for instance that can always meaning something injured the hypothalamus or the pituitary gland because it's either

one of those that gets injured which are they're in the brain right so any of those injured by any of

these or let's say stroke I mentioned stroke which is a cerebral vascular disease right uh can cause diabetes in

citus the nephrogenic is kind of different because this one the patient may have adequate anti-erotic hormone

but then the kidneys don't respond to it okay or it can also be secondary which is secondary means it's caused by

something else usually drug induced like lithium is very notorious for causing diabetes

Inus manifestation so this patient in all respects the patient is dehydrated because they pee so

much I had one uh high school friend uh who had it and she was carrying jugs of water when she goes around

okay so her was she had some type of um a small brain tumor that was what triggered her diabetes CPUs so it's not

permanent okay so she got treatment she got chemo radiation surgery and then uh the DI went

away but if you look at this patient they're dehydrated so heart rate tie blood pressure is low bu and creatin

high The Only Exception is in the urine because if the patient is peeing a lot what does the urine look

like which is opposite right it's it's like um what do you call that term it's um um what's a

term yeah another term for that it's um no the term it'll come back to me okay um

okay okay um anyway so the patient who's dehydrated is supposed to have concentrated urine correct this one they

do not the patient's urine here looks like they're included overloop because it looks diluted it has a low specific

gravity okay which is opposite right it's supposed to be high specific gravity and very concentrated if you're

dehydrated but no not in this particular example okay so this is just one exception all right so don't be so so

come exam one don't be distracted by that okay because again this patient when you look at them all other labs

they look dehydrated okay as with anybody else who's losing so much fluid okay they

they're dehydrated however the urine is different okay the urine looks like they're in fluid

overl treatment oh um the sodium here will be high not because they they took a lot of sodium but because of the

severe dehydration so there is hypernatremia as a result of loss of blood volume so they lost so much water

that the sodium levels rise for Diagnostic testing uh I already mentioned you know the urine will look

different okay specific gravity will be low concentration or marity will also be low and of course

the sodium levels will be high treatment of course we need to treat the underlying cost but uh since not all

causes let's say stroke that's not that is that easy to treat not really right head trauma so therefore treatment will

be based on what's the nature of the disorder again what does the patient have doesn't have enough of anti diotic

hormone so we will give them the anti- dtic hormone it comes in a drug called deso PR now you it comes in a vial no

sorry it comes in an ampu so therefore you have to draw it with a filter needle okay so when the

pharmacy sends it up to you it will come with a filter needle unless if you have filter needles already in your med room

uh which not all hospitals have that but any way so they'll send you the ampu and then it it'll come with the

filter needle the other treatments the other drugs here are for supported purpose

only let's say vasopressin for instance Vaso constrictor so this will help increase blood pressure so there

symptomatic uh treatment to um main you know to maintain perfusion maintain blood pressure

and of course we give the patient um lots of fluids so if they're still conscious we give it by mouth but not

likely right because I mean can you drink one liter per hour no so it's going to have to be

IV if it's nephrogenic then these are the drugs that will be avoided biasa diuretics prostag glanded Inhibitors

like indomethacin and aspirin uh aspirin is just one nid so basically all

nids are prandin inhibitor so this will include also uh so these are two nids indomethacin and aspirin so we've got

ibuprofen as well so those are also prandin Inhibitors nursing management because

this is a fluid deficit patient right so same as we discussed last week so you weigh a patient daily check Bal signs

check labs that's it any questions let's go straight to the opposite problem siadh

so similar to di this one the causes are also similar these are the

known uh culprits for causing s ADH brain surgery head injury infection meaning brain infection like menitis for

instance so these are all known causes for sadh cancer is also a known uh trigger uh as well as cancer treatment

so when we discuss chemotherapy next week this will be mentioned again as one of the complications

okay so this is opposite so if we had we didn't have enough ADH and diabetes Inus this one this patient has way too much

both by the way diabetes CPUs and sadh are emergencies meaning what could possibly happen if you have way too much

anti-erotic hormone what what could kill you fluid overload especially heart failure so you go into P acute pulmonary

EMA severe heart failure and then death will follow okay so this is an emergency right in

fact this is one of the six oncologic emergency meaning cancer emergencies treatment it's self-limiting

however since the patient really has severe when the patient has a severe case of course we have to uh treat acute

pulmonary edema correct which is acute heart failure so on top of restriction of

fluids this patient also by the way has symptomatic hyponatremia the because of the large

amounts of water being reabsorbed the sodium levels drop dramatically causing cerebral edema so these patient can go

into seizures right so we need to treat the the sodium levels here because it they're yeah they it's not like they

lost the sodium sodium is still in the body however because of the severe fluid overload yeah the the the massive

reabsorption of uh water and there therefore what would happen to this patients urine

output if they're reabsorbing too much water okay they'll go oorc or even anuic so we restrict fluids and then

give the patient diuretics uh and then we'll treat the you remember the vaptan drugs last

week call vaptan and con B yes so we'll give those as well again only we can only give those drugs where in a

hospital setting okay either given IV or po um but again because the side effect is severe hypernatremia

potentially so we only give that in admitted patient on in patients only so diuretic agents keep in mind

though diuretics especially furos yes it will excrete water but what will

also okay now not just potassium okay this will also excrete sodium okay so be careful uh when you administer diuretics

okay because it will deplete everything and if that's the case a patient may instead of uh diuretic they

may receive hypertonic saline instead but also keep in mind what's a side effect effect of a hypertonic

solution load overload as well so be careful as well if the doctor orders that and just like di or any other fluid

electrolyte case so you monitor the same things weigh the patient daily accurate IO uh please keep in mind we have

non-invasive ways to let's say the patient is in continent right so so we have non-invasive ways

to still measure outut early I mean not not early but uh urine output through uh

pure Wick okay we have pure Wick prait meaning you don't have to put in a fley okay however if we have really critical

patients wherein we need hourly urine output the only way to do that is with a fle catheter

that's it