BySheenaHowson,MD2182011.pptVIP

Diabetes Insipidus Goal is to restore plasma volume and serum Na+ levels Patient with intact thirst mechanism Pitcher at bedside. Drink to thirst only! Severe forms Replace UOP 1:1 with 1/2NS DDAVP 5u SQ Q4-6h, commonly given orally/nasally DDAVP will be ineffective if nephrogenic HCTZ can be used By Sheena Howson, MD 2/18/2011 SIADH Inappropriate secretion of ADH Water excretion is impaired Suppression of ADH is impaired Functions of ADH Increases permeability of water in the cells of the distal tubules by upregulating Aquaporin-2 channels V2 receptors Increases the permeability of collecting ducts to urea Increases SVR via IP3/Ca++ 2nd messengers on endothelium CNS effects like memory formation and circadian rhythm SIADH - causes Intracranial – infection, stroke, hemorrhage, tumor, very common in SAH population 69% Intrathoracic – malignancy, abscess, PNA, effusion, PTX, chest wall deformity Drugs – vasopressin, DDAVP, oxytocin, analgesics, antidepressants, amiodarone, antipsychotics, sulfonylureas, carbamazepine, cyclophosphamide Extracranial tumors – small-cell lung CA, pancreatic CA HIV/AIDS Hereditary – “gain-of-function” V2 receptor mutation Miscellaneous – Guillan-Barre, nausea, stress, pain, acute psychosis Major surgery **** Idiopathic SIADH Hypothalamus receives feedback from: Osmoreceptors Aortic arch baroreceptors Carotid baroreceptors Atrial stretch receptors Any increase in osmolality or decrease in blood volume will stimulate ADH secretion from posterior pituitary. SIADH - pathophysiology ADH-induced water retention Dilutional hyponatremia Volume expansion - secondary natriuresis Sodium and water loss Potassium loss Result: Euvolemic hyponatremia Reduced serum osmolality Increased urine osmolality Increased urine sodium SIADH - diagnosis Laboratory Findings Na 135 mEq/L Posm 300 mOsm/kg UNa 25 mEq/L Low BUN Normal Cr Low uric acid Low albumin SIADH - treatment Treat the underlying cause, if known Fluid Restriction – commonly