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    Di and Siadh

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    Sandra Martini Simmons
    1. Disorders of the posterior pituitary gland can cause diabetes insipidus (DI) or syndrome of inappropriate antidiuretic hormone secretion (SIADH). 2. DI is caused by a deficiency of antidiuretic hormone (ADH) and results in excessive urine production and thirst. It can be neurogenic, due to issues with the hypothalamus or pituitary, or nephrogenic, where the kidneys do not respond to ADH. 3. SIADH is caused by excessive ADH levels despite normal fluid volume, leading to low serum sodium and fluid retention.

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    Di and Siadh

    Uploaded by

    Sandra Martini Simmons
    105 views15 pages
    1. Disorders of the posterior pituitary gland can cause diabetes insipidus (DI) or syndrome of inappropriate antidiuretic hormone secretion (SIADH). 2. DI is caused by a deficiency of antidiuretic hormone (ADH) and results in excessive urine production and thirst. It can be neurogenic, due to issues with the hypothalamus or pituitary, or nephrogenic, where the kidneys do not respond to ADH. 3. SIADH is caused by excessive ADH levels despite normal fluid volume, leading to low serum sodium and fluid retention.

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    1. Disorders of the posterior pituitary gland can cause diabetes insipidus (DI) or syndrome of inappropriate antidiuretic hormone secretion (SIADH). 2. DI is caused by a deficiency of antidiuretic hormone (ADH) and results in excessive urine production and thirst. It can be neurogenic, due to issues with the hypothalamus or pituitary, or nephrogenic, where the kidneys do not respond to ADH. 3. SIADH is caused by excessive ADH levels despite normal fluid volume, leading to low serum sodium and fluid retention.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    105 views15 pages

    Di and Siadh

    Uploaded by

    Sandra Martini Simmons
    1. Disorders of the posterior pituitary gland can cause diabetes insipidus (DI) or syndrome of inappropriate antidiuretic hormone secretion (SIADH). 2. DI is caused by a deficiency of antidiuretic hormone (ADH) and results in excessive urine production and thirst. It can be neurogenic, due to issues with the hypothalamus or pituitary, or nephrogenic, where the kidneys do not respond to ADH. 3. SIADH is caused by excessive ADH levels despite normal fluid volume, leading to low serum sodium and fluid retention.

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    of 15

    Posterior Pituitary Disorders

    Diabetes Insipidus and SIADH

    Disorders Associated with ADH


    ADH Anti-Diuretic Hormone (Vasopressin) Produced in hypothalamus Stored in the posterior pituitary gland Acts on the renal collecting tubules & results in water reabsorption

    Diabetes Insipidus (DI)


    Pathophysiology
    Deficiency in synthesis or release of antidiuretic hormone (ADH) Excess water losses Neurogenic versus nephrogenic
    NeurogenicADH deficiency Nephrogenickidneys insensitive to ADH

    Secondary causes
    Excessive intake (IV or PO)

    DI: Etiology Neurogenic


    Trauma to pituitary or hypothalamus
    Head trauma, hypophysectomy, tumor

    DI: Etiology Nephrogenic


    Chronic Renal disease Drugs (alcohol, phenytoin, lithium)

    DI: Clinical Signs


    High urine output; low specific gravity Thirst Dehydration Central nervous system signs of volume depletion

    DI Assessment Clinical Picture of Dehydration


    Polyuria 5-40L/24 hr Urine pale & dilute Polydipsia Thirst Polyphagia Dehydration Constipation Thick secretions Hypovolemia hypotension, skin turgor, dry MM, tachycardia, wt loss, CVP & PCWP Confusion Restlessness Seizures Coma

    DI: Diagnostics
    Serum Na - >145 mEq/L (due to loss of fluid) ADH - (neurogenic); (nephrogenic kidneys insensitive to ADH); Dilute urine with specific gravity - <1.005

    DI: Interventions
    Fluids; assess for hypovolemia ADH replacement (neurogenic) vasopressin (DDAVP)
    Side effects: HA, nausea, mild abdominal cramps Note: watch for overload

    DI: Interventions
    Nephrogenic (kidneys insensitive to ADH)
    Thiazide diuretics Sodium restriction

    10

    Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH)


    Pathophysiology
    Excess ADH Plasma hypo-osmolality

    11

    SIADH: Etiology
    Malignancy Pulmonary disorders Lung CA, TB, COPD, Pneumonia, Mech Ventilation Central nervous system trauma, brain tumors

    12

    SIADH: Assessment Clinical Picture of Water Intoxication


    CV: wt gain, HTN, RAP>10, PCWP>12, Neuro: confusion, restlessness, lethargy, diff concentrating, HA, seizures, coma Renal: dark urine, UOP GI: N/V/A, BS, muscle cramps Resp: tachypnea, dyspnea, adventitious sounds, frothy pink sputum

    13

    SIADH: Assessment - Lab


    Serum Na: <135 mEq/L (dilutional) Serum Osmolality: <275 mOsm/Kg H2O Serum ADH: elevated Urine Na: >20 mEq/L

    14

    SIADH Interventions
    Fluid restriction (800 to 1000 mL/day) Diet liberal in sodium If needed, hypertonic saline and diuretics (Lasix) Monitor intake and output, specific gravity, weights

    15

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