DI1.pptx lecture slide for bachelor students

this lecture slide is useful for nursing students

1. Mr Yogendra Mehta Lecturer, HOD(AHD) BRNC Diabetes Insipidus

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:

6. Etiology Primary – Idiopathic Secondary Head trauma Neuro surgery Tumors (Intra cranial) Vascular Infection (Meningitis) Longstanding renal disease Hypokalemia .

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

14. Surgical management 1.) Hypophysectomy :- - Removal of pituitary gland may be performed for the treatment of primary tumor of the pituitary gland.

15. complication Electrolyte imbalance Hypotension Hypovolemia Shock Death

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.