endocrine- siadh, diabetes insipidus

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  1. pituary gland
    adenohypophysis
    • anterior lobe
    • 70% of gland
    • releases 6 hormones to target lands
    • - GH, ACTH, TSH, prolactin, FSH, LH
    • production and release reg. by hypothalmus
  2. pituitary gland
    neurohypophysis
    • posterior lobe
    • storage site
    • secretes oxytocin and ADH
    • - synthesis is in hypothalamus, stored in posterior pituary
  3. diabetes indipidus
    • deficiency or absence of ADH- cental DI
    • inability to respond to ADH- nephrogenic DI
    • - kidney no longer responds to ADH
  4. DI
    patho
    • ADH release is stimulated by OSMO receptors in hypothalmus, baroreceptors in carotid, aortic arch
    • decr ADH leads to lg amount of dilute urine--- no signal to stop
    • specific gravity is low
  5. DI
    classic
    • dilute, polyuria
    • intense thirst
    • r/t dec ADH
  6. DI
    manifestations/DX tests
    • sudden polyuria  nocturia
    • polydipsia           wt loss
    • fatigue               constipation
    • dilute urine         incr serum osmo (is incre b/c loss of blood)
    • water deprivation test: 8-12 hours nothing to drink0 to see if output reduce
  7. DI
    management
    • assess I&O, daily wt
    • assess dehydration
    • pt education
    • - life long tx (central)- don't know what it is
    • - nephogenic: renal- tx underlying cause
    • - medical id
  8. DI
    management meds
    • synthetic ADH
    • -DDAVP intranasal, SC, IV- vasopressin
    • vasopressin
    • - pitressin intranasal, SC, IV: vasoconstriction, careful w/pt w/cardiac
    • thiazide diuretic- mild form, incr affects of ADH
  9. SIADH
    • inapproriate incr release of ADH leads to:
    • water intoxication, hypotonicity of plasma
    • fluid expansion
    • hypoatremia
  10. SIADH causes
    • neoplastic tumors- esp lung- tumor stimulates ADH production
    • resp disorders- chronic
    • hyperpitutarism
    • renal disorders
    • drugs- chemo/antineoplastic drugs, oral hypoglycemic, thiazide duirec, ssri
  11. SIADH
    • incr ADH leads to volume
    • Na is lost in urine
    • result is
    • decre serum osmo
    • h20 intoxication (fluid retention)
    • hypoantremia
  12. SIADH
    s/s dx test
    • acute rapid neuro chx- memory, mental chx
    • - dec LOC
    • - Loss of DTR
    • - seizures to coma
  13. SIADH chronic
    • hypoatremia
    • weight gain
    • incr urine osm- kidney not working??
    • CNS chx, h/a mild/gradual
    • GI: n/v
  14. SIADH: management
    acute
    • NA< 120 = CNS effects= emergency
    • incre serun NA, not too rapidly
    • - 3-5% NS w/na, IV lasix
    • D/C drugs: if med induced
    • becareful of lytes- for hypo kal/atremia
  15. SIADH management chronic
    • fluid restriction 500-100 m/d
    • declomycin- interfers w/ADH se suprainfection
    • monitor I&O, wt, lytes, neuro s/s
    • teaching about fluid restriction, med, f/u

Card Set Information

Author:
Prittyrick
ID:
319265
Filename:
endocrine- siadh, diabetes insipidus
Updated:
2016-04-23 05:02:02
Tags:
adh di
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to pee or not to pee
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