2. DEFINITION
It is a disorder of water metabolism caused by
deficiency of ADH (Vasopresin) or by inability of the
kidneys to respond to ADH.
3. FORMS OF DI
1. Transient DI:
Abrupt onset within first few after neuro surgery
resolve within several days.
2. Permanent DI:
Abrupt and early onset, persists for several weeks
or forever. Usually occurs after damage to
hypothalamus or Neurohypophyseal damage.
4. CONT….
3. Triphasic DI:
Immediate post injury increases Urine volume
with decrease in urine osmolity lasting 4-5days and
followed by permanent phase of polyuria.
4. Nephrogenic:
Rare Hereditary disorder acquired structural or
functional changes in kidney occurs. ADH produced
normally, but distal and collecting tubules cannot
respond.
5. CONT….
5. Complete DI:
When there is disruption of hypophyseal tract
and a complete absence of ADH.
6. Neurogenic DI:
CNS interruption of anatomic integrity of
posterior pituitary. ADH synthesis or release is
affected, may be transient or permanent.
7. Idiopathic DI:
7. PATHOPHYSIOLOGY
Due to etiological factor
Deficiency of ADH
Permeability of water is diminished
Excretion of Large volumes of hypotonic fluid
8. CONT….
Note:
Normally ADH increases kidneys permeability to water
to promote water reabsorption and decrease urine
output.
ADH is normally released in response to increase
serum osmolality and decrease Extracellular volume.
9. CLINICAL MANIFESTATION
i.Genito Urinary :
* Polyuria (few liters to 18 l/day )
* Clear urine
* Urinary Frequency
* Nocturia
ii. Gastro Intestinal:
*Weight loss
* Polydipsia (if thirst mechanism intact 4 to
40 l/day)
* Has craving for cold water.
10. CONT….
iii.Integumentary:
*Dry skin and mucous membrane
iv. Neurologic:
* Electrolyte Imbalance
* Hypotention
v. High serum osmolality
vi. High serum sodium level.
11. DIAGNOSTIC EVALUATION
History collection
Physical Examination
Water deprivation test
Hyper-tonic Saline test
Urine output
Serum Na+ level
Plasma and Serum Osmolality
12. MEDICAL MANAGEMENT
Administration of ADH or its derivative:
a) Vasopressin (Pitressin)
- IM, Effective for 24 to72hrs.
- Vial should be warmed and shaken vigorously before
administrating to mix active component settles at bottom of
vial.
b) Lypressin (Diapid nasal Spray)
- Absorbed through nasal mucosa
- Duration of action 4 to 6 hrs
- may cause chronic nasal irritation.
13. CONT….
c) Desmo-pressin acetate.
- Vasopressin deratives administered into the nose through a
soft, flexible nasal.
- Duration of action 12 to 24 hrs
- For patient who have some residual hypothalamic ADH.
d) Chloropropamide:
- Potenciate action of reducing polyuria.
e) Hydro – Chlorothiacin:
- Reduce the urine volume
- Dose 20 – 75 mg /kg/day
16. NURSING DIAGNOSIS
Risk for fluid volume deficit r/t disease process.
Imbalanced Nutrition Less than Body Requirements
related to insufficiency of insulin, decreased
oral input.
Fluid Volume Deficit related to osmotic diuresis.
Risk for Infection related to hyperglycemia.
