Nephrogenic DI: kidneys do not respond to ADH - inadequate water reabsorption
Neurogenic DI: a defect in either the production of secretion of ADH. Can result from tumors, head trauma, infection, surgical procedures
Pathophysiology: ADH deficiency or inability of kidneys to respond to ADH results in the excretion of large volumes of very dilute urine. Massive diuresis resulting in increased plasma osmalarity which stimulates the osmoreceptors. Massive dehydration ensues = decreased intravascular volume, hypotension, and circulatory collapse. Causes dysrhythmias and impaired contractility of the heart. If left untreated, severe cases can lead to cardiac arrest or death.
S/S: Major diuresis, dehydration (hypotension, tachycardia, dizziness, decreased skin turgor, weakness, and possible fainting), and thirst. Malaise, lethargy, irritability, irregular heartbeat.
Usually results from a sudden marked decrease in available adrenal hormones. Precipitating factors are adrenal surgery, pituitary destruction, abrupt withdrawal of steroid therapy, and stress.
Stressors include infection, illness, trauma, and emotional or psychiatric disturbances.
S/S: Hypotension, tachycardia, dehydration, confusion, hyponatremia, hyperkalemia, hypercalcemia, and hypoglycemia.
Pt should always wear medical bracelet with notifications of Addisonian Crisis
Used to treat adrenal insufficiency.
Side effects: hypokalemia, hypocalcemia, N/V, edema, hypertension, increased risk for infection, hyperglycemia, muscle wasting, osteoporosis, ulcer development, acne, pathologic fractures. May cause death if suddenly dc'd.
Monitor wt, I&O, BP, glucose. Assess for edema. Protect from infection sources. Give oral drugs with food or milk.
Tissues can't use glucose without insulin, increase in osmotic pressure, reabsorption of water, increased urine output, large amounts of dilute urine, glycogen to glucose (glycogenolysis), body burns fat for energy, produces acidic substances (ketones), excess ketones cause decrease in pH of blood = acidosis, increased nitrogen secretion (depletion in body)
S/S: dehydration, weakness, lethargic with abdominal pain, nausea, vomiting, fruity breath, increased resp, tachycardia, blurred vision, and hypothermia. Later signs are air hunge (Kussmaul)
S/S: Weakness, hunger, diaphoresis, tremors, anxiety, irritability, headace, pallor, and tachycardia. Also confusion, weakness, dizziness, blurred or double vision, seizures, and sometimes coma.
Based on Whipples Triad: 1-presence of symptoms 2-documentation of low blood glucose when symptoms occur 3-improvement of those symptoms when blood glucose rises