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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

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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, 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

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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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