Buzz Words polyuria ADH deficiency Diabetes Insipidus Hallmark 1. DI is caused by an ADH insufficiency Epidemiology Pathophysiology Cause: Same causes as hypopituitarism (slide 26) Post-surgical is most common Leads to a loss of ADH and thus, inability to concentrate urine and regulate sodium balance in the serum ADH: acts on the distal tubule and collecting duct of the kidney to increase water reabsorption into the serum Lowers hyperosmolarity and raises hypervolemia by thirst mechanism Central: low ADH levels released from pituitary Can be complete or partial Nephrogenic: kidney is unresponsive to ADH Clinical Manifestation/ Clinical Presentation/ Physical Exam Polyuria >3L/nocturia Polydipsia Dehydration Cravings for ice water Children may have enuresis HYPERnatremia (weakness, AMS, seizures) Differential Diagnosis Work Up Lab Tests/ Radiology Urine sample for analysis of concentration Low urine osmolality (can be high with partial DI) High plasma osmolality Fluid deprivation test (use only when plasma Osm normal and pt having hypotonic polyuria) to compare urine and plasma Osm Treatment 1. ADH analog = DDAVP a. Subcutaneous, intranasaly, orally depending on how bad it is, their sxs 2. Start 0.05mg BID (max 0.4mg q8) 3. Assess for improvement in sx = decreased urine output, increased urine osmolality, and decreased thirst 4. When stable dose is found, drink only when
Transcript
Buzz Words polyuria ADH deficiency
Diabetes Insipidus
Hallmark
1. DI is caused by an ADH insufficiencyEpidemiologyPathophysiology Cause:
Same causes as hypopituitarism (slide 26) Post-surgical is most common Leads to a loss of ADH and thus, inability to concentrate urine and
regulate sodium balance in the serum ADH: acts on the distal tubule and collecting duct of the kidney to
increase water reabsorption into the serum Lowers hyperosmolarity and raises hypervolemia by thirst
mechanism Central: low ADH levels released from pituitary Can be complete or partial Nephrogenic: kidney is unresponsive to ADH
Polyuria >3L/nocturia Polydipsia Dehydration Cravings for ice water Children may have enuresis HYPERnatremia (weakness, AMS, seizures)
Differential DiagnosisWork UpLab Tests/ Radiology
Urine sample for analysis of concentration Low urine osmolality (can be high with partial DI) High plasma osmolality Fluid deprivation test (use only when plasma Osm normal and pt
having hypotonic polyuria) to compare urine and plasma Osm
Treatment 1. ADH analog = DDAVPa. Subcutaneous, intranasaly, orally depending on how bad it is,
their sxs2. Start 0.05mg BID (max 0.4mg q8)3. Assess for improvement in sx = decreased urine output, increased urine
osmolality, and decreased thirst 4. When stable dose is found, drink only when thirsty VERY IMPT
Side Effects & ComplicationsHealth MaintenanceMonitoringAnatomy
Images
Buzz Words Too much
ADHSIADHsyndrome of inappropriate antidireutic hormone secretion
Hallmark 1. Syndrome of inappropriate antidiuretic hormone hypersecretion 2. Most common cause of HYPOnatremia leading to elevated urine
osmolality and low plasma osmolality from excess ADH release 3. Opposite of DI
EpidemiologyPathophysiology Water retention leads to hyponatremia and decreased plasma osmolalityClinical Manifestation/Clinical Presentation/ Physical Exam
no symptomsslow/mildly developing hyponatremiaNO edema
Hyponatremia <125mEq/L (normal is 125-141)Low or low-normal serum concentration of urea and uric acidLow serum osmolalityConcentrated urineElevated circulating vasopressinUrine osmolality of >300nmol/kg
Treatment 1. Treat with water restriction FIRST2. Replace Na3. Demeclocycline 600-1200mg bid-qid or Lithium carbonate 600-
1200mg bid-qid4. High Na diet
Side Effects & ComplicationsHealth MaintenanceMonitoringAnatomyImages
Buzz Words Hypoglycemia
Hallmark
1. A blood glucose of <80mg/dLEpidemiologyPathophysiology Insulin
New Onset:Non-Compliance:Abnormally High: look for cause- infection, CBC, Urinalysis, Chest XrayDKA:HHS:
Treatment New Onset DM:1. Hydration 2. Glucotrol (glipizide), Glucagon3. Follow up
Non-Compliance:1. Make sure they are not DKA2. IV Fluids3. Education, Follow up
Abnormally High:1. IV Fluids
Side Effects & ComplicationsHealth MaintenanceMonitoringAnatomyImages
Buzz Words Diabetic Ketoacidosis
Hallmark Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Ketones in the bloodAcidosis
Epidemiology DKA occurs mostly in type 1 diabetes. Mortality 1-10%
Pathophysiology Insulin deficiency causes the body to metabolize triglycerides and muscle instead of glucose for energySerum levels of glycerol and free fatty acids (FFAs) rise because of unrestrained lipolysis, as does alanine from muscle catabolism. Hyperglycemia caused by insulin deficiency produces an osmotic diuresis that leads to marked urinary losses of water and electrolytes
nauseavomiting abdominal pain high blood glucose: high meter reading at homeUsually blood glucose is >250If meter says high it is >500
Differential DiagnosisWork UpLab Tests/ Radiology
DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. BMP, CBC if glucose is >250A-B-CLook for underlying causes such as infection, MI: CIP (cardiac injury profile), CXR- look for pneumonia, UA- look for ketones in urineCBC- looking for infectionBMP (anion gap): Na, Cl, K, CO2, BUN, CrSerum KetonesArterial Blood Gas (pH < 7.35)UA (+glucose, +ketones)
Treatment Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia
Side Effects & Complications can progress to cerebral edema, coma, and death.Health MaintenanceMonitoringAnatomy
Images
Buzz Words Hyperosmolar Hyperglycemic StateHHS (HHNK)
Hallmark
Epidemiology High Mortality Rate It most often occurs in type 2 DM, often in the setting of physiologic stress.
Nonketotic hyperosmolar syndrome (NKHS) is a metabolic complication of diabetes mellitus (DM) characterized by: hyperglycemia, extreme dehydration, hyperosmolar plasma, and altered consciousness.NKHS is diagnosed by severe hyperglycemia and serum hyperosmolarity and absence of significant ketosis.
Treatment Treatment is IV normal saline (10Liter average deficit), insulin, monitor & correct K+, evaluate for underlying causeIn ICU
Side Effects & Complications Complications include coma, seizures, and death
