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Posterior

Pituitary

Disorders

Disorders Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH
Diabetes Insipidus and SIADH

Diabetes Insipidus and SIADH

Disorders Diabetes Insipidus and SIADH
Disorders Diabetes Insipidus and SIADH
Disorders Diabetes Insipidus and SIADH
Disorders Diabetes Insipidus and SIADH
Disorders Diabetes Insipidus and SIADH
Disorders Diabetes Insipidus and SIADH

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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

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Diabetes Insipidus (DI)

Pathophysiology

Deficiency in synthesis or release of antidiuretic hormone (ADH) Excess water losses Neurogenic versus nephrogenic

Neurogenic—ADH deficiency Nephrogenic—kidneys insensitive to ADH

Secondary causes

Excessive intake (IV or PO)

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DI: Etiology Neurogenic

Trauma to pituitary or hypothalamus

Head trauma, hypophysectomy, tumor

DI: Etiology Neurogenic Trauma to pituitary or hypothalamus Head trauma, hypophysectomy, tumor 4

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DI: Etiology Nephrogenic

Chronic Renal disease Drugs (alcohol, phenytoin, lithium)

DI: Etiology Nephrogenic Chronic Renal disease Drugs (alcohol, phenytoin, lithium) 5

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DI: Clinical Signs

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

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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

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DI: Diagnostics
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

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DI: Interventions

Fluids; assess for hypovolemia ADH replacement (neurogenic)— vasopressin (DDAVP)

Side effects: HA, nausea, mild abdominal cramps

Note: watch for overload

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DI: Interventions

Nephrogenic (kidneys insensitive to ADH)

Thiazide diuretics Sodium restriction

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Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH)

Pathophysiology

Excess ADH Plasma hypo-osmolality

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SIADH: Etiology

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

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SIADH: Assessment – Clinical Picture of Water Intoxication

CV: wt gain, HTN, RAP>10, PCWP>12, Neuro: confusion,

l diff concentrating, HA, seizures, coma Renal: dark urine, ↓ UOP

tl

th

res essness, e

argy,

GI: N/V/A, ↓ BS, muscle cramps

Resp: tachypnea,

d

sounds, frothy pink sputum

d

yspnea, a ven

titi

ous

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SIADH: Assessment - Lab

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

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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

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